Provider Demographics
NPI:1578778916
Name:CROSSROADS BEHAVIORAL HEALTH
Entity Type:Organization
Organization Name:CROSSROADS BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM ADMINISTRATOR
Authorized Official - Prefix:MS
Authorized Official - First Name:VICTORIA
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:PFEIFFER
Authorized Official - Suffix:
Authorized Official - Credentials:CDP
Authorized Official - Phone:509-427-7100
Mailing Address - Street 1:240 SW CASCADE AVE.
Mailing Address - Street 2:PO BOX 906
Mailing Address - City:STEVENSON
Mailing Address - State:WA
Mailing Address - Zip Code:98648-0906
Mailing Address - Country:US
Mailing Address - Phone:509-427-7100
Mailing Address - Fax:509-427-7105
Practice Address - Street 1:240 SW CASCADE AVE.
Practice Address - Street 2:
Practice Address - City:STEVENSON
Practice Address - State:WA
Practice Address - Zip Code:98648-0906
Practice Address - Country:US
Practice Address - Phone:509-427-7100
Practice Address - Fax:509-427-7105
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-11
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WA30103000251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA30103000OtherSTATE CERTIFICATION NUMBE
WA1994797Medicaid