Provider Demographics
NPI:1134291271
Name:CROSSROADS COUNSELING SERVICES, LLC
Entity type:Organization
Organization Name:CROSSROADS COUNSELING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER AND DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:KAREN
Authorized Official - Middle Name:J
Authorized Official - Last Name:KOLTIS
Authorized Official - Suffix:
Authorized Official - Credentials:MS,LPC,LMFT,CADC
Authorized Official - Phone:715-644-4357
Mailing Address - Street 1:224 S BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:STANLEY
Mailing Address - State:WI
Mailing Address - Zip Code:54768-1011
Mailing Address - Country:US
Mailing Address - Phone:715-644-4357
Mailing Address - Fax:715-644-5053
Practice Address - Street 1:224 S BROADWAY ST
Practice Address - Street 2:
Practice Address - City:STANLEY
Practice Address - State:WI
Practice Address - Zip Code:54768-1011
Practice Address - Country:US
Practice Address - Phone:715-644-4357
Practice Address - Fax:715-644-5053
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-14
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI2219101YA0400X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI42218300Medicaid
WI42218300Medicaid