=====================================================
General NPI Number Information
=====================================================
NPI Number | 1427109719
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CROSSROADS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2007
-----------------------------------------------------
Last Update Date | 08/22/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 15 PINECREST DR
-----------------------------------------------------
City | ESSEX JUNCTION
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05452-2912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-288-1087
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 15 PINECREST DR
-----------------------------------------------------
City | ESSEX JUNCTION
-----------------------------------------------------
State | VT
-----------------------------------------------------
Zip | 05452-2912
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 802-288-1087
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CLINICAL DIRECTOR
-----------------------------------------------------
Name | MS. JODIE BISSON
-----------------------------------------------------
Credential | M.A.
-----------------------------------------------------
Telephone | 802-288-1087
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YM0800X
-----------------------------------------------------
Taxonomy Name | Mental Health Counselor
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------