Healthcare Provider Details

I. General information

NPI: 1558396689
Provider Name (Legal Business Name): DEACONESS CROSS POINTE CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 03/10/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

920 FREDERICA ST
OWENSBORO KY
42301-3050
US

IV. Provider business mailing address

PO BOX 8127
EVANSVILLE IN
47716-8127
US

V. Phone/Fax

Practice location:
  • Phone: 270-686-8984
  • Fax: 270-689-0054
Mailing address:
  • Phone: 812-450-6815
  • Fax: 812-450-6822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: DAVID MORRIS
Title or Position: CEO
Credential:
Phone: 812-476-7200