MEDICARE: CROSSWAY COUNSELING SERVICES LLC

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1457613002
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSWAY COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	109 W MAIN ST
Second Line	:	SUITE B
City	:	DAVIS
State	:	OK
Zip	:	73030-1775
Country	:	US
Telephone Number	:	580-369-0498
Fax Number	:

Provider Business Practice Location Address
First Line	:	109 W MAIN ST
Second Line	:	SUITE B
City	:	DAVIS
State	:	OK
Zip	:	73030-1775
Country	:	US
Telephone Number	:	580-369-0498
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	MRS. RHONDA WESBERRY
Credential	:
Telephone Number	:	580-369-0498

Provider Enumeration Date	:	06/11/2012
Last Update Date	:	06/11/2012

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Directions to “CROSSWAY COUNSELING SERVICES LLC ” Practice Location

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