Healthcare Provider Details

I. General information

NPI: 1548860448
Provider Name (Legal Business Name): CROSS COUNTRY COUNSELING PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/29/2020
Last Update Date: 10/29/2020
Certification Date: 10/29/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

237 TAYLOR ST UNIT 2
PORT TOWNSEND WA
98368-5766
US

IV. Provider business mailing address

PO BOX 393
PORT TOWNSEND WA
98368-0393
US

V. Phone/Fax

Practice location:
  • Phone: 360-436-6363
  • Fax:
Mailing address:
  • Phone: 360-436-6363
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SARA SMITHSON
Title or Position: OWNER
Credential: LCSW, LICSW
Phone: 360-436-6363