Provider Demographics
NPI:1922318351
Name:CROSSROADS COUNSELING SERVICES, CORP
Entity Type:Organization
Organization Name:CROSSROADS COUNSELING SERVICES, CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CARRIE
Authorized Official - Middle Name:L
Authorized Official - Last Name:CERRETA-KESSIE
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:303-503-5225
Mailing Address - Street 1:1360 S WADSWORTH BLVD STE 209
Mailing Address - Street 2:
Mailing Address - City:LAKEWOOD
Mailing Address - State:CO
Mailing Address - Zip Code:80232-5414
Mailing Address - Country:US
Mailing Address - Phone:303-503-5225
Mailing Address - Fax:
Practice Address - Street 1:1360 S WADSWORTH BLVD STE 209
Practice Address - Street 2:
Practice Address - City:LAKEWOOD
Practice Address - State:CO
Practice Address - Zip Code:80232-5414
Practice Address - Country:US
Practice Address - Phone:303-503-5225
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-10-19
Last Update Date:2022-01-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC3013251S00000X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO04022858Medicaid
CO75089700Medicaid