Provider Demographics
NPI:1912434184
Name:CORNERSTONE CLINIC, LLC
Entity type:Organization
Organization Name:CORNERSTONE CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL SOCIAL WORKER/OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:
Authorized Official - Last Name:KREHBIEL
Authorized Official - Suffix:
Authorized Official - Credentials:MSW LSCSW
Authorized Official - Phone:785-452-2034
Mailing Address - Street 1:631 E CRAWFORD ST STE 209
Mailing Address - Street 2:
Mailing Address - City:SALINA
Mailing Address - State:KS
Mailing Address - Zip Code:67401-5116
Mailing Address - Country:US
Mailing Address - Phone:785-452-2034
Mailing Address - Fax:785-404-6365
Practice Address - Street 1:631 E CRAWFORD ST STE 209
Practice Address - Street 2:
Practice Address - City:SALINA
Practice Address - State:KS
Practice Address - Zip Code:67401-5116
Practice Address - Country:US
Practice Address - Phone:785-452-2034
Practice Address - Fax:785-404-6365
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS40441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty