Healthcare Provider Details

I. General information

NPI: 1982973236
Provider Name (Legal Business Name): CROSSROADS COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/15/2011
Last Update Date: 12/15/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

600 N MAIN ST
MOUNTAIN GROVE MO
65711-1309
US

IV. Provider business mailing address

600 N MAIN ST
MOUNTAIN GROVE MO
65711-1309
US

V. Phone/Fax

Practice location:
  • Phone: 417-926-7623
  • Fax:
Mailing address:
  • Phone: 417-926-7623
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State

VIII. Authorized Official

Name: MS. MICHELLE D COLLINS
Title or Position: OFFICE MANAGER
Credential:
Phone: 417-926-7623