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General NPI Number Information
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NPI Number | 1619274883
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Entity Type | Organization
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Legal Business Name | CROSSROAD COUNSELING SERVICES
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Dates
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Enumeration Date | 02/23/2011
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Last Update Date | 02/23/2011
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Provider Practice Location Address
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Address Line | 33530 1ST WAY S SUITE 102
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City | FEDERAL WAY
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State | WA
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Zip | 98003-7332
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Country | US
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Telephone | 253-426-5319
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Fax |
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Provider Business Mailing Address
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Address Line | 1933 NORMA RD NE
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City | TACOMA
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State | WA
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Zip | 98422-1342
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | DIRECTOR/OWNER
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Name | MS. NICOLE COOPE
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Credential | MSC, LMHC
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Telephone | 253-426-5319
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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 | LH60127666
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License Number State | WA
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