Provider Demographics
NPI:1114579026
Name:CROSSROADS COUNSELING
Entity Type:Organization
Organization Name:CROSSROADS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:G
Authorized Official - Last Name:ALLPHIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:660-537-3537
Mailing Address - Street 1:1665 COUNTY ROAD 442
Mailing Address - Street 2:
Mailing Address - City:NEW FRANKLIN
Mailing Address - State:MO
Mailing Address - Zip Code:65274-9500
Mailing Address - Country:US
Mailing Address - Phone:660-537-3537
Mailing Address - Fax:
Practice Address - Street 1:600 W MORRISON ST
Practice Address - Street 2:
Practice Address - City:FAYETTE
Practice Address - State:MO
Practice Address - Zip Code:65248-1471
Practice Address - Country:US
Practice Address - Phone:660-537-3537
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-07-10
Last Update Date:2019-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO0528Medicaid