NPIMap

Organization Active NPI

Cornerstone Community Counseling Corp

  • Psychologist
  • Imboden, AR
National Provider Identifier
1346463353
Registry record updated Mar 27, 2012
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
Legal business name
CORNERSTONE COMMUNITY COUNSELING CORP
Practice address
609 W 3Rd St
Imboden, AR 72434-9099
Phone
(870) 869-1500
Fax
(870) 869-1505
NPI assigned
Apr 10, 2007
Organization subpart
No

Authorized official

NPPES NPI Registry
Name
Mrs. Brenda Marie Ray, MRC, LPC
Title
Ceo
Phone
(870) 869-1500

Practitioners 18

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

View all 18

National Provider Directory

National Provider Directory

Locations

609 W 3rd St
Imboden, AR 72434
Phone (870) 869-2385

Specialties & licenses 2

NPPES NPI Registry
Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X Primary
Community/Behavioral Health Agency 251S00000X

Addresses

NPPES NPI Registry

Primary practice location

609 W 3Rd St
Imboden, AR 72434-9099

Mailing address

609 W 3Rd St
Imboden, AR 72434-9099
Phone (870) 869-1500

Other identifiers 2

NPPES NPI Registry
IdentifierTypeStateIssuer
164272526MedicaidAR
172732526MedicaidAR

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format, last updated by the provider on Mar 27, 2012.

{
    "created_epoch": "1176163200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1332806400000",
    "number": "1346463353",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "609 W 3RD ST",
            "city": "IMBODEN",
            "state": "AR",
            "postal_code": "724349099",
            "telephone_number": "870-869-1500",
            "fax_number": "870-869-1505"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "609 W 3RD ST",
            "city": "IMBODEN",
            "state": "AR",
            "postal_code": "724349099",
            "telephone_number": "870-869-1500",
            "fax_number": "870-869-1505"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE COMMUNITY COUNSELING CORP",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-04-10",
        "last_updated": "2012-03-27",
        "status": "A",
        "authorized_official_last_name": "RAY",
        "authorized_official_first_name": "BRENDA",
        "authorized_official_middle_name": "MARIE",
        "authorized_official_title_or_position": "CEO",
        "authorized_official_telephone_number": "870-869-1500",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "MRC, LPC"
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "251S00000X",
            "taxonomy_group": "",
            "desc": "Community/Behavioral Health",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "164272526",
            "state": "AR"
        },
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "172732526",
            "state": "AR"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Imboden, AR

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 27, 2012; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.