Provider Demographics
NPI:1215392196
Name:CROSSROADS COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:CROSSROADS COUNSELING CENTER, LLC
Other - Org Name:CORNERSTONE COUNSELING CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:MISS
Authorized Official - First Name:JENNA
Authorized Official - Middle Name:MARIE
Authorized Official - Last Name:MORTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:775-337-9359
Mailing Address - Street 1:1280 TERMINAL WAY
Mailing Address - Street 2:SUITE 3
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502
Mailing Address - Country:US
Mailing Address - Phone:775-337-9359
Mailing Address - Fax:775-337-9360
Practice Address - Street 1:1280 TERMINAL WAY
Practice Address - Street 2:SUITE 3
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502-3219
Practice Address - Country:US
Practice Address - Phone:775-337-9359
Practice Address - Fax:775-337-9360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-21
Last Update Date:2015-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVNV20151558013251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health