Provider Demographics
NPI:1487022083
Name:CROSSROADS COUNSELING SERVICES PC
Entity Type:Organization
Organization Name:CROSSROADS COUNSELING SERVICES PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, CEO
Authorized Official - Prefix:
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:A
Authorized Official - Last Name:CHARRON
Authorized Official - Suffix:
Authorized Official - Credentials:LIMHP, PLADC
Authorized Official - Phone:308-384-7119
Mailing Address - Street 1:2121 N WEBB RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAND ISLAND
Mailing Address - State:NE
Mailing Address - Zip Code:68803-1751
Mailing Address - Country:US
Mailing Address - Phone:308-384-7119
Mailing Address - Fax:308-384-7119
Practice Address - Street 1:2121 N WEBB RD
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAND ISLAND
Practice Address - State:NE
Practice Address - Zip Code:68803-1751
Practice Address - Country:US
Practice Address - Phone:308-384-7119
Practice Address - Fax:308-384-7119
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-13
Last Update Date:2015-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NELIMHP # 89101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE100254520-00Medicaid