Provider Demographics
NPI:1619028909
Name:CROSSROADS COUNSELING & TRAINING SERVICES
Entity Type:Organization
Organization Name:CROSSROADS COUNSELING & TRAINING SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NICOLE
Authorized Official - Middle Name:
Authorized Official - Last Name:NELSON
Authorized Official - Suffix:
Authorized Official - Credentials:MPS
Authorized Official - Phone:907-455-9737
Mailing Address - Street 1:PO BOX 82074
Mailing Address - Street 2:
Mailing Address - City:FAIRBANKS
Mailing Address - State:AK
Mailing Address - Zip Code:99708-2074
Mailing Address - Country:US
Mailing Address - Phone:907-455-9737
Mailing Address - Fax:
Practice Address - Street 1:3180 PEGER RD
Practice Address - Street 2:SUITE 200
Practice Address - City:FAIRBANKS
Practice Address - State:AK
Practice Address - Zip Code:99709-5484
Practice Address - Country:US
Practice Address - Phone:907-455-9737
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-15
Last Update Date:2017-03-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AKHC5957251C00000X, 385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
AKHC5957Medicaid
AKCMG957Medicaid