Provider Demographics
NPI:1386461077
Name:CORNERSTONE COUNSELING CENTER, PLLC
Entity type:Organization
Organization Name:CORNERSTONE COUNSELING CENTER, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:NICHOLAS
Authorized Official - Middle Name:
Authorized Official - Last Name:GAMMELLO
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:218-838-4209
Mailing Address - Street 1:11636 FAIRWAY RD
Mailing Address - Street 2:
Mailing Address - City:EAST GULL LAKE
Mailing Address - State:MN
Mailing Address - Zip Code:56401-2099
Mailing Address - Country:US
Mailing Address - Phone:218-838-4209
Mailing Address - Fax:
Practice Address - Street 1:18510 MN-371
Practice Address - Street 2:SUITE D
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401
Practice Address - Country:US
Practice Address - Phone:218-838-4209
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-24
Last Update Date:2024-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health