Healthcare Provider Details

I. General information

NPI: 1215392196
Provider Name (Legal Business Name): CROSSROADS COUNSELING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/21/2015
Last Update Date: 12/21/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1280 TERMINAL WAY SUITE 3
RENO NV
89502-3219
US

IV. Provider business mailing address

1280 TERMINAL WAY SUITE 3
RENO NV
89502
US

V. Phone/Fax

Practice location:
  • Phone: 775-337-9359
  • Fax: 775-337-9360
Mailing address:
  • Phone: 775-337-9359
  • Fax: 775-337-9360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberNV20151558013
License Number StateNV

VIII. Authorized Official

Name: MISS JENNA MARIE MORTON
Title or Position: MANAGING MEMBER
Credential:
Phone: 775-337-9359