Healthcare Provider Details

I. General information

NPI: 1396211587
Provider Name (Legal Business Name): CROSSROADS COUNSELING SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2018
Last Update Date: 10/23/2023
Certification Date: 09/23/2021
Deactivation Date: 08/31/2023
Reactivation Date: 10/23/2023

III. Provider practice location address

255 W MAIN ST
SAINT CLAIRSVILLE OH
43950-1040
US

IV. Provider business mailing address

PO BOX 118
SAINT CLAIRSVILLE OH
43950-0118
US

V. Phone/Fax

Practice location:
  • Phone: 740-695-9447
  • Fax: 740-695-8895
Mailing address:
  • Phone: 740-695-9447
  • Fax: 740-695-8895

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: LISA ANN JONES
Title or Position: BILLING COORDINATOR
Credential:
Phone: 740-695-9447