Healthcare Provider Details

I. General information

NPI: 1407329469
Provider Name (Legal Business Name): CROSSROADS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/02/2019
Last Update Date: 01/31/2025
Certification Date: 01/31/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

843 N WASHINGTON AVE
EMMETT ID
83617-5076
US

IV. Provider business mailing address

843 N WASHINGTON AVE
EMMETT ID
83617-5076
US

V. Phone/Fax

Practice location:
  • Phone: 208-365-3141
  • Fax: 208-398-8311
Mailing address:
  • Phone: 208-365-3141
  • Fax: 208-398-8311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code175T00000X
TaxonomyPeer Specialist
License Number
License Number State

VIII. Authorized Official

Name: JILL J SPRAGUE
Title or Position: OWNER
Credential: MA, LCPC
Phone: 208-365-3141