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General NPI Number Information
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NPI Number | 1154831105
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Entity Type | Organization
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Legal Business Name | KIDS CROSSING
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Dates
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Enumeration Date | 10/04/2017
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Last Update Date | 10/04/2017
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Provider Practice Location Address
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Address Line | 414 BROADWAY AVE
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City | PUEBLO
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State | CO
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Zip | 81004-2128
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Country | US
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Telephone | 719-545-3382
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Fax | 719-632-6573
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Provider Business Mailing Address
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Address Line | 1440 E FOUNTAIN BLVD
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City | COLORADO SPRINGS
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State | CO
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Zip | 80910-3502
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Country | US
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Telephone | 719-632-4569
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | WILLIAM LEE OESTERLE
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Credential |
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Telephone | 719-510-6659
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number |
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License Number State |
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