MEDICARE: CROSWAITE COUNSELING, PLLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1396356200
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSWAITE COUNSELING, PLLC

Provider Business Mailing Address
First Line	:	7700 E ACADEMY BLVD UNIT 305
Second Line	:
City	:	DENVER
State	:	CO
Zip	:	80230-7169
Country	:	US
Telephone Number	:	720-245-7390
Fax Number	:

Provider Business Practice Location Address
First Line	:	1768 SILVER MEADOW CIR
Second Line	:
City	:	COLORADO SPRINGS
State	:	CO
Zip	:	80951-9762
Country	:	US
Telephone Number	:	720-336-0481
Fax Number	:

Authorized Official
Title or Position	:	OWNER, CROSWAITE COUNSELING, PLLC
Name	:	KHARA KAY CROSWAITE BRINDLE
Credential	:	MA LPC ACS
Telephone Number	:	720-245-7390

Provider Enumeration Date	:	08/13/2020
Last Update Date	:	11/27/2023

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