Provider Demographics
NPI:1396356200
Name:CROSWAITE COUNSELING, PLLC
Entity Type:Organization
Organization Name:CROSWAITE COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CROSWAITE COUNSELING, PLLC
Authorized Official - Prefix:
Authorized Official - First Name:KHARA
Authorized Official - Middle Name:KAY
Authorized Official - Last Name:CROSWAITE BRINDLE
Authorized Official - Suffix:
Authorized Official - Credentials:MA LPC ACS
Authorized Official - Phone:720-245-7390
Mailing Address - Street 1:7700 E ACADEMY BLVD UNIT 305
Mailing Address - Street 2:
Mailing Address - City:DENVER
Mailing Address - State:CO
Mailing Address - Zip Code:80230-7169
Mailing Address - Country:US
Mailing Address - Phone:720-245-7390
Mailing Address - Fax:
Practice Address - Street 1:1768 SILVER MEADOW CIR
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80951-9762
Practice Address - Country:US
Practice Address - Phone:720-336-0481
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROSWAITE COUNSELING, PLLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2020-08-13
Last Update Date:2023-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO13305034Medicaid