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General NPI Number Information
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NPI Number | 1760828545
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Entity Type | Organization
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Legal Business Name | CROSS KEYS EQUINE THERAPY
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Dates
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Enumeration Date | 05/20/2013
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Last Update Date | 09/22/2021
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Provider Practice Location Address
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Address Line | 6107 HORSE FARM LN
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City | PORT REPUBLIC
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State | VA
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Zip | 24471-2634
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Country | US
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Telephone | 540-607-6910
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Fax |
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Provider Business Mailing Address
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Address Line | 6107 HORSE FARM LN
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City | PORT REPUBLIC
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State | VA
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Zip | 24471-2634
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Country | US
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Telephone | 540-607-6910
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Fax |
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Authorized Official
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Title or Position | MENTAL HEALTH COUNSELOR
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Name | AUSTIN CANALE MIKOLIN
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Credential | LPC
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Telephone | 540-280-0243
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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 |
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License Number State |
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