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General NPI Number Information
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NPI Number | 1134621691
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Entity Type | Organization
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Legal Business Name | CROSSINGS CHRISTIAN COUNSELING
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Dates
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Enumeration Date | 03/01/2018
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Last Update Date | 03/01/2018
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Provider Practice Location Address
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Address Line | 1002 WEST MAIN
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City | OAK GROVE
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State | LA
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Zip | 71263-7126
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Country | US
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Telephone | 318-537-6220
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Fax |
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Provider Business Mailing Address
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Address Line | 7099 HIGHWAY 2
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City | OAK GROVE
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State | LA
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Zip | 71263-8392
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Country | US
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Telephone | 318-537-6220
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Fax |
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Authorized Official
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Title or Position | COUNSELOR
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Name | PATRICIA TAMMETTE BULLOCK
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Credential | LPC
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Telephone | 318-537-6220
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number | 6359
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License Number State | LA
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