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General NPI Number Information
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NPI Number | 1487022083
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Entity Type | Organization
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Legal Business Name | CROSSROADS COUNSELING SERVICES PC
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Dates
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Enumeration Date | 09/13/2015
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Last Update Date | 09/15/2015
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Provider Practice Location Address
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Address Line | 2121 N WEBB RD SUITE 200
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City | GRAND ISLAND
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State | NE
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Zip | 68803-1751
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Country | US
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Telephone | 308-384-7119
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Fax | 308-384-7119
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Provider Business Mailing Address
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Address Line | 2121 N WEBB RD SUITE 200
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City | GRAND ISLAND
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State | NE
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Zip | 68803-1751
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Country | US
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Telephone | 308-384-7119
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Fax | 308-384-7119
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Authorized Official
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Title or Position | OWNER, CEO
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Name | KIMBERLY A. CHARRON
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Credential | LIMHP, PLADC
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Telephone | 308-384-7119
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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 | LIMHP # 89
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License Number State | NE
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