Provider Demographics
NPI:1952148835
Name:CORNERSTONE BEHAVIORAL HEALTH LLC
Entity type:Organization
Organization Name:CORNERSTONE BEHAVIORAL HEALTH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LADWANA
Authorized Official - Middle Name:
Authorized Official - Last Name:RETIC
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:702-499-4312
Mailing Address - Street 1:3315 E RUSSELL RD # A4-348
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-3440
Mailing Address - Country:US
Mailing Address - Phone:702-499-4312
Mailing Address - Fax:
Practice Address - Street 1:6260 MCLEOD DR STE 100
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89120-4445
Practice Address - Country:US
Practice Address - Phone:702-499-4312
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-09
Last Update Date:2024-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Single Specialty