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General NPI Number Information
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NPI Number | 1770970337
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Entity Type | Organization
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Legal Business Name | CROSSROAD CHILD AND FAMILY SERVICES
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Dates
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Enumeration Date | 04/22/2015
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Last Update Date | 04/22/2015
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Provider Practice Location Address
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Address Line | 2525 LAKE AVE
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City | FORT WAYNE
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State | IN
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Zip | 46805-5407
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Country | US
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Telephone | 260-484-4153
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Fax | 260-496-5996
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Provider Business Mailing Address
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Address Line | 2525 LAKE AVE
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City | FORT WAYNE
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State | IN
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Zip | 46805-5407
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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 | THERAPIST
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Name | ASHLEE RAGER
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Credential | MSED., LMFT
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Telephone | 260-484-4153
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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