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General NPI Number Information
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NPI Number | 1194122275
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Entity Type | Organization
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Legal Business Name | CROSSWAY COUNSLING LLC
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Dates
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Enumeration Date | 12/04/2014
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Last Update Date | 12/04/2014
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Provider Practice Location Address
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Address Line | 9420 SOUTH RED MAN RD.
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City | RAVIA
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State | OK
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Zip | 73455
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Country | US
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Telephone | 580-371-7328
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Fax |
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Provider Business Mailing Address
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Address Line | 9420 SOUTH RED MAN RD.
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City | RAVIA
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State | OK
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Zip | 73455
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Country | US
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Telephone | 580-371-7328
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Fax |
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Authorized Official
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Title or Position | OFFICE ASSISTANT
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Name | MRS. KIMBERLY GILBERT
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Credential |
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Telephone | 580-371-9933
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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