Provider Demographics
NPI:1760828545
Name:CROSS KEYS EQUINE THERAPY
Entity Type:Organization
Organization Name:CROSS KEYS EQUINE THERAPY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:AUSTIN
Authorized Official - Middle Name:CANALE
Authorized Official - Last Name:MIKOLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:540-280-0243
Mailing Address - Street 1:6107 HORSE FARM LN
Mailing Address - Street 2:
Mailing Address - City:PORT REPUBLIC
Mailing Address - State:VA
Mailing Address - Zip Code:24471-2634
Mailing Address - Country:US
Mailing Address - Phone:540-607-6910
Mailing Address - Fax:
Practice Address - Street 1:6107 HORSE FARM LN
Practice Address - Street 2:
Practice Address - City:PORT REPUBLIC
Practice Address - State:VA
Practice Address - Zip Code:24471-2634
Practice Address - Country:US
Practice Address - Phone:540-607-6910
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-20
Last Update Date:2021-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health