1669594180 NPI number — CROSSROADS COUNSELING & CONSULTING INCORPORATED

Table of content: (NPI 1669594180)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1669594180 NPI number — CROSSROADS COUNSELING & CONSULTING INCORPORATED

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSSROADS COUNSELING & CONSULTING INCORPORATED
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CROSSROADS SOLUTIONS
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1669594180
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2 5TH ST N
Provider Second Line Business Mailing Address:
SUITE 204
Provider Business Mailing Address City Name:
GREAT FALLS
Provider Business Mailing Address State Name:
MT
Provider Business Mailing Address Postal Code:
59401-4010
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
406-727-5046
Provider Business Mailing Address Fax Number:
406-727-5047

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2 5TH ST N
Provider Second Line Business Practice Location Address:
SUITE 204
Provider Business Practice Location Address City Name:
GREAT FALLS
Provider Business Practice Location Address State Name:
MT
Provider Business Practice Location Address Postal Code:
59401-4010
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
406-727-5046
Provider Business Practice Location Address Fax Number:
406-727-5047
Provider Enumeration Date:
04/04/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BOYLE
Authorized Official First Name:
JOSEPH
Authorized Official Middle Name:
PATRICK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
406-727-5046

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  153LCSW , registered in the state of MT ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 284290 . This is a "VALUE OPTIONS" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 70480 . This is a "BLUE CROSS BLUE SHIELD MT" identifier , issued by the state of ( MT ) . This identifiers is of the category "OTHER".
  • Identifier: 0000503081 , issued by the state of ( MT ) . This identifiers is of the category "MEDICAID".




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