Healthcare Provider Details

I. General information

NPI: 1972911212
Provider Name (Legal Business Name): CROSSROADS THERAPY SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2014
Last Update Date: 07/30/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MAIN ST
ELKINS WV
26241-4105
US

IV. Provider business mailing address

201 MAIN ST
ELKINS WV
26241-4105
US

V. Phone/Fax

Practice location:
  • Phone: 304-637-4644
  • Fax: 304-637-4645
Mailing address:
  • Phone: 304-637-4644
  • Fax: 304-637-4645

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License NumberWV1335
License Number StateWV

VIII. Authorized Official

Name: LONA MARKLEY
Title or Position: OWNER/OCCUPATIONAL THERAPIST
Credential: MOTR
Phone: 304-637-4644