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General NPI Number Information
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NPI Number | 1629673991
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Entity Type | Organization
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Legal Business Name | CROSSROADS COUNSELING CARE INC
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Dates
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Enumeration Date | 12/03/2020
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Last Update Date | 12/03/2020
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Provider Practice Location Address
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Address Line | 555 FALLS BLVD N
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City | WYNNE
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State | AR
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Zip | 72396-2611
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Country | US
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Telephone | 870-318-0565
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Fax |
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Provider Business Mailing Address
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Address Line | 555 FALLS BLVD N
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City | WYNNE
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State | AR
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Zip | 72396-2611
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Country | US
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Telephone | 870-318-0565
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | WILLIAM DAVID EIDT
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Credential | LPC
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Telephone | 870-318-0565
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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 |
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License Number State |
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