Provider Demographics
NPI:1598752370
Name:CROSSROADS COUNSELING, INC.
Entity Type:Organization
Organization Name:CROSSROADS COUNSELING, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:KATHLEEN
Authorized Official - Middle Name:
Authorized Official - Last Name:FREEBIRD
Authorized Official - Suffix:
Authorized Official - Credentials:LISW
Authorized Official - Phone:505-624-0486
Mailing Address - Street 1:207 N UNION AVE
Mailing Address - Street 2:SUITE G
Mailing Address - City:ROSWELL
Mailing Address - State:NM
Mailing Address - Zip Code:88201-3068
Mailing Address - Country:US
Mailing Address - Phone:505-624-0486
Mailing Address - Fax:505-624-3210
Practice Address - Street 1:207 N UNION AVE
Practice Address - Street 2:SUITE G
Practice Address - City:ROSWELL
Practice Address - State:NM
Practice Address - Zip Code:88201-3068
Practice Address - Country:US
Practice Address - Phone:505-624-0486
Practice Address - Fax:505-624-3210
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-05
Last Update Date:2007-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-048001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NM000B0036Medicaid
66935OtherPRESBYTERIAN HEALTH CARE
NMNM00RE39OtherBLUE CROSS BLUE SHIELD
NMNM102138OtherVALUE OPTIONS
NM000B0036Medicaid