Healthcare Provider Details

I. General information

NPI: 1336234913
Provider Name (Legal Business Name): CROSSROADS COUNSELING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/03/2006
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8 NORTH GROVE STREET SUITE FOUR
LOCK HAVEN PA
17745
US

IV. Provider business mailing address

501 EAST THIRD STREET
WILLIAMSPORT PA
17701
US

V. Phone/Fax

Practice location:
  • Phone: 570-893-1886
  • Fax: 570-893-1850
Mailing address:
  • Phone: 570-323-7535
  • Fax: 570-323-3790

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number187037
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number187037
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number187037
License Number StatePA
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number187037
License Number StatePA

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

# 1
Identifier1007434200004
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1007434200006
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier1007434200009
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 4
Identifier999029
Identifier TypeOTHER
Identifier StatePA
Identifier IssuerBC/BS PROVIDER #

VIII. Authorized Official

Name: WILLIAM E KNECHT
Title or Position: DIRECTOR
Credential:
Phone: 570-323-7535