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General NPI Number Information
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NPI Number | 1043651052
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Entity Type | Organization
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Legal Business Name | CROSSROADS COUNSELING SERVICES LLC
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Dates
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Enumeration Date | 07/08/2013
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Last Update Date | 07/08/2013
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Provider Practice Location Address
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Address Line | 6053 HUDSON RD STE 192
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City | WOODBURY
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State | MN
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Zip | 55125-1015
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Country | US
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Telephone | 651-276-8446
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Fax |
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Provider Business Mailing Address
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Address Line | 6053 HUDSON RD STE 192
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City | WOODBURY
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State | MN
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Zip | 55125-1015
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Country | US
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Telephone | 651-276-8446
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Fax |
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Authorized Official
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Title or Position | OWNER/THERAPIST
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Name | BRENDA KITTILSON
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Credential | MS, LICSW, LADC
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Telephone | 651-276-8446
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 301518
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License Number State | MN
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Taxonomy #2
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Taxonomy Code | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 13033
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License Number State | MN
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