Healthcare Provider Details

I. General information

NPI: 1417774084
Provider Name (Legal Business Name): CROSSROADS COUNSELING SERVICES, PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/24/2024
Last Update Date: 09/24/2024
Certification Date: 09/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1802 N DIVISION ST STE 509
MORRIS IL
60450-3107
US

IV. Provider business mailing address

1802 N DIVISION ST STE 509
MORRIS IL
60450-3107
US

V. Phone/Fax

Practice location:
  • Phone: 815-941-3882
  • Fax:
Mailing address:
  • Phone: 815-941-3882
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code276400000X
TaxonomySubstance Use Disorder Rehabilitation Hospital Unit
License Number
License Number State

VIII. Authorized Official

Name: ANGELA SOLIS
Title or Position: OWNER
Credential:
Phone: 815-941-3882