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General NPI Number Information
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NPI Number | 1740016096
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Entity Type | Organization
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Legal Business Name | CROSSROADS CHURCH AN EVANGELICAL FREE CHURCH
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Dates
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Enumeration Date | 09/12/2024
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Last Update Date | 09/12/2024
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Provider Practice Location Address
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Address Line | 1360 N JOHNSON RD
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City | TURLOCK
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State | CA
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Zip | 95380-3507
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Country | US
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Telephone | 209-585-3173
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Fax |
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Provider Business Mailing Address
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Address Line | 1360 N JOHNSON RD
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City | TURLOCK
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State | CA
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Zip | 95380-3507
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Country | US
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Telephone | 209-585-3173
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Fax |
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Authorized Official
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Title or Position | DIRECTOR OF COUNSELING
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Name | MATHEW COTTON
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Credential | LMFT
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Telephone | 209-585-3713
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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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Taxonomy #2
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number |
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License Number State |
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Taxonomy #3
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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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Taxonomy #4
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Taxonomy Code | 1041S0200X
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Taxonomy Name | School Social Worker
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License Number |
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License Number State |
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Taxonomy #5
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Taxonomy Code | 390200000X
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Taxonomy Name | Student in an Organized Health Care Education/Training Program
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License Number |
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License Number State |
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Taxonomy #6
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number |
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License Number State |
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