1598752370 NPI number — CROSSROADS COUNSELING, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1598752370 NPI number — CROSSROADS COUNSELING, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSSROADS COUNSELING, INC.
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:
Provider Other Organization Name Type Code:
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:
1598752370
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/10/2007
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
207 N UNION AVE
Provider Second Line Business Mailing Address:
SUITE G
Provider Business Mailing Address City Name:
ROSWELL
Provider Business Mailing Address State Name:
NM
Provider Business Mailing Address Postal Code:
88201-3068
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-624-0486
Provider Business Mailing Address Fax Number:
505-624-3210

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
207 N UNION AVE
Provider Second Line Business Practice Location Address:
SUITE G
Provider Business Practice Location Address City Name:
ROSWELL
Provider Business Practice Location Address State Name:
NM
Provider Business Practice Location Address Postal Code:
88201-3068
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
505-624-0486
Provider Business Practice Location Address Fax Number:
505-624-3210
Provider Enumeration Date:
10/05/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FREEBIRD
Authorized Official First Name:
KATHLEEN
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER, PROVIDER
Authorized Official Telephone Number:
505-624-0486

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  I-04800 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 000B0036 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".
  • Identifier: 66935 . This is a "PRESBYTERIAN HEALTH CARE" identifier . This identifiers is of the category "OTHER".
  • Identifier: NM00RE39 . This is a "BLUE CROSS BLUE SHIELD" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".
  • Identifier: NM102138 . This is a "VALUE OPTIONS" identifier , issued by the state of ( NM ) . This identifiers is of the category "OTHER".




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