NPIMap

Organization Active NPI

Cornerstone Therapy and Recovery Center, P.a.

  • Psychologist
  • Saint Paul, MN
National Provider Identifier
1700895968
Registry record updated Aug 22, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
PsychologistTaxonomy code 103T00000X
License
LP 2974 Issued in MN
Legal business name
CORNERSTONE THERAPY AND RECOVERY CENTER, P.A.
Practice address
1600 University Ave W Ste 505
Saint Paul, MN 55104-3825
Phone
(651) 645-0980
Fax
(651) 645-3534
NPI assigned
Aug 5, 2006
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Aug 22, 2020

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Michael Lee Kogan-White, M.A.NPI 1346259504
Title
President and Ceo
Phone
(651) 645-0980

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
PsychologistGroup: 193200000X MULTI-SPECIALTY GROUP 103T00000X LP 2974 MN Primary

Addresses

Primary practice location

1600 University Ave W Ste 505
Saint Paul, MN 55104-3825

Mailing address

1600 University Ave W Ste 505
Saint Paul, MN 55104-3825
Phone (651) 645-0980

National Provider Directory

National Provider Directory

Locations

1600 University Ave W
Ste 505
Saint Paul, MN 55104
Phone (651) 645-0980

Practitioners & affiliated clinicians

Practitioners 5

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

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154736000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1598054400000",
    "number": "1700895968",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "1600 UNIVERSITY AVE W STE 505",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043825",
            "telephone_number": "651-645-0980",
            "fax_number": "651-645-3534"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "1600 UNIVERSITY AVE W STE 505",
            "city": "SAINT PAUL",
            "state": "MN",
            "postal_code": "551043825",
            "telephone_number": "651-645-0980",
            "fax_number": "651-645-3534"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CORNERSTONE THERAPY AND RECOVERY CENTER, P.A.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-05",
        "last_updated": "2020-08-22",
        "status": "A",
        "authorized_official_last_name": "KOGAN-WHITE",
        "authorized_official_first_name": "MICHAEL",
        "authorized_official_middle_name": "LEE",
        "authorized_official_title_or_position": "PRESIDENT AND CEO",
        "authorized_official_telephone_number": "651-645-0980",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "M.A."
    },
    "taxonomies": [
        {
            "code": "103T00000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Psychologist",
            "state": "MN",
            "license": "LP 2974",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Saint Paul, MN

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Aug 22, 2020; 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.