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Organization

CORNERSTONE WELLNESS CENTER LLC

Active
Organization subpart
No

Provider details

NPI number
Authorized official
MR. THOMAS LEE MILLARD P.H.D (PSYCHOLOGIST)
(563) 243-6054
Entity
Organization

Contact information

Practice address
1523 S BLUFF BLVD, CLINTON, IA 52732-6549
(563) 243-6054
(563) 243-6828
Mailing address
1523 S BLUFF BLVD, CLINTON, IA 52732-6549
(563) 243-6054
(563) 243-6828

Taxonomy

Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
1041C0700X
Clinical Social Worker
207Q00000X
Family Medicine Physician
2084P0800X
Psychiatry Physician

Other

Other identifiers
Code
Description
Identifier
Issuer
State
01
23379
BLUE CROSS BLUE SHIELD
IA
Enumeration date
08/15/2006
Last updated
09/20/2011
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