Healthcare Provider Details

I. General information

NPI: 1225574072
Provider Name (Legal Business Name): CROSSPOINT COMMUNITY COUNSELING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2017
Last Update Date: 02/22/2024
Certification Date: 02/22/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3101 N HEMLOCK CIR SUITE 100
BROKEN ARROW OK
74012-1103
US

IV. Provider business mailing address

3101 N HEMLOCK CIR SUITE 100
BROKEN ARROW OK
74012-1103
US

V. Phone/Fax

Practice location:
  • Phone: 918-615-3435
  • Fax: 918-615-3436
Mailing address:
  • Phone: 918-615-3435
  • Fax: 918-615-3436

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateOK

VIII. Authorized Official

Name: MR. MERLE BROCK
Title or Position: OWNER/THERAPIST
Credential: LMFT
Phone: 918-615-3435