Provider Demographics
NPI:1659701100
Name:DEMIAN WOOD LLC
Entity Type:Organization
Organization Name:DEMIAN WOOD LLC
Other - Org Name:CROSSROADS CHRISTIAN COUNSELING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:DEMIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:WOOD
Authorized Official - Suffix:
Authorized Official - Credentials:MA LMFT
Authorized Official - Phone:970-206-4472
Mailing Address - Street 1:1218 HAWKEYE CT
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-8831
Mailing Address - Country:US
Mailing Address - Phone:970-206-4472
Mailing Address - Fax:
Practice Address - Street 1:1218 HAWKEYE CT
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-8831
Practice Address - Country:US
Practice Address - Phone:970-206-4472
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-20
Last Update Date:2013-11-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COMFT706101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty