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General NPI Number Information
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NPI Number | 1225315773
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Entity Type | Organization
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Legal Business Name | CROSSROADS BEHAVIORAL HEALTH, P.L.C.
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Dates
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Enumeration Date | 11/11/2011
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Last Update Date | 11/11/2011
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Provider Practice Location Address
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Address Line | 218 ALLEGHENY AVE SUITE 101
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City | WABASHA
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State | MN
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Zip | 55981-1252
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Country | US
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Telephone | 651-560-7103
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Fax |
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Provider Business Mailing Address
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Address Line | 218 ALLEGHENY AVE SUITE 101
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City | WABASHA
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State | MN
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Zip | 55981-1252
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Country | US
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Telephone | 651-560-7103
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Fax |
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Authorized Official
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Title or Position | OWNER/ORGANIZER
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Name | SUSAN ELIZABETH PERSONS
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Credential | MS, LP
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Telephone | 651-560-7103
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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 | 4390940-2
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License Number State | MN
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