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General NPI Number Information
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NPI Number | 1578372686
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Entity Type | Organization
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Legal Business Name | CROSSLAND COMMUNITY BAPTIST CHURCH, INC.
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Dates
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Enumeration Date | 01/03/2025
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Last Update Date | 01/28/2025
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Provider Practice Location Address
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Address Line | 600 US 31W BYP STE 18D
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City | BOWLING GREEN
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State | KY
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Zip | 42101-4906
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Country | US
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Telephone | 270-780-4311
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Fax |
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Provider Business Mailing Address
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Address Line | 600 US 31W BYP STE 18D
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City | BOWLING GREEN
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State | KY
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Zip | 42101-4906
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Country | US
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Telephone | 270-780-4311
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | GREGG FARRELL
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Credential |
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Telephone | 270-842-4428
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number |
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License Number State |
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