Healthcare Provider Details

I. General information

NPI: 1609199322
Provider Name (Legal Business Name): CROSSROADS COUNSELING, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/09/2010
Last Update Date: 05/31/2023
Certification Date: 05/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

444 E COLLEGE AVE SUITE 460
STATE COLLEGE PA
16801-5558
US

IV. Provider business mailing address

444 E COLLEGE AVE SUITE 460
STATE COLLEGE PA
16801-5558
US

V. Phone/Fax

Practice location:
  • Phone: 814-231-0940
  • Fax:
Mailing address:
  • Phone: 814-231-0940
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number StatePA
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number147021
License Number StatePA
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number147021
License Number StatePA
# 5
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number147021
License Number StatePA

VII. Legacy identifiers

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

# 1
Identifier1007434200012
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 2
Identifier1007434200010
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer
# 3
Identifier1007434200014
Identifier TypeMEDICAID
Identifier StatePA
Identifier Issuer

VIII. Authorized Official

Name: MR. BILL KNECHT
Title or Position: DIRECTOR
Credential:
Phone: 570-323-7535