Provider Demographics
NPI:1427205111
Name:CROSSROADS COUNSELING SERVICES, PLLC
Entity Type:Organization
Organization Name:CROSSROADS COUNSELING SERVICES, PLLC
Other - Org Name:CROSSROADS COUNSELING SERVICES, PLLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SOLIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:815-941-3882
Mailing Address - Street 1:1802 N DIVISION ST STE 509
Mailing Address - Street 2:
Mailing Address - City:MORRIS
Mailing Address - State:IL
Mailing Address - Zip Code:60450-3107
Mailing Address - Country:US
Mailing Address - Phone:815-941-3882
Mailing Address - Fax:815-941-3884
Practice Address - Street 1:1802 N DIVISION ST STE 509
Practice Address - Street 2:
Practice Address - City:MORRIS
Practice Address - State:IL
Practice Address - Zip Code:60450-3107
Practice Address - Country:US
Practice Address - Phone:815-941-3882
Practice Address - Fax:815-941-3884
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-25
Last Update Date:2023-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL14623101YA0400X
IL180003593101YP2500X
IL1490117601041C0700X
261QM0850X, 261QM0855X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Single Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Single Specialty
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental HealthGroup - Single Specialty