| Cornerstone Behavioral Health Llc | |
|
17415 Northwood Ave #201 Lakewood OH 44107-3909 | |
| (216) 302-4077 | |
| (888) 684-5911 |
| Full Name | Cornerstone Behavioral Health Llc |
|---|---|
| Speciality | Counselor |
| Location | 17415 Northwood Ave #201, Lakewood, Ohio |
| Authorized Official Name and Position | Caleb Folkerts (OWNER) |
| Authorized Official Contact | 6189731889 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Cornerstone Behavioral Health Llc 14837 Detroit Ave # 193 Lakewood OH 44107-3909 Ph: (618) 973-1889 | Cornerstone Behavioral Health Llc 17415 Northwood Ave #201 Lakewood OH 44107-3909 Ph: (216) 302-4077 |
| NPI Number | 1700407517 |
|---|---|
| Provider Enumeration Date | 05/04/2020 |
| Last Update Date | 01/07/2025 |
| Certification Date | 01/01/2025 |
| Medicare PECOS PAC ID | 4385000587 |
|---|---|
| Medicare Enrollment ID | O20230512001969 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1700407517 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (* (Not Available)) | Primary |
| Provider Name | Nancy M Distefano |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1699124198 PECOS PAC ID: 5799053013 Enrollment ID: I20170609001004 |
| Provider Name | Kelly M Salapski |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1871198077 PECOS PAC ID: 3870987134 Enrollment ID: I20220302001579 |
| Provider Name | Danny Miller |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1215414628 PECOS PAC ID: 0143564252 Enrollment ID: I20230727002247 |
| Provider Name | Meghan Fawcett |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1457503435 PECOS PAC ID: 4183075278 Enrollment ID: I20240112003922 |
| Provider Name | Caleb Folkerts |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1326691403 PECOS PAC ID: 6103282306 Enrollment ID: I20240507000510 |
| Provider Name | Kristi Anderson Wilson |
|---|---|
| Provider Type | Practitioner - Mental Health Counselor |
| Provider Identifiers | NPI Number: 1649697822 PECOS PAC ID: 7517309487 Enrollment ID: I20240523000583 |
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