Provider Demographics
NPI:1134621691
Name:CROSSINGS CHRISTIAN COUNSELING
Entity type:Organization
Organization Name:CROSSINGS CHRISTIAN COUNSELING
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:TAMMETTE
Authorized Official - Last Name:BULLOCK
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:318-537-6220
Mailing Address - Street 1:7099 HIGHWAY 2
Mailing Address - Street 2:
Mailing Address - City:OAK GROVE
Mailing Address - State:LA
Mailing Address - Zip Code:71263-8392
Mailing Address - Country:US
Mailing Address - Phone:318-537-6220
Mailing Address - Fax:
Practice Address - Street 1:1002 WEST MAIN
Practice Address - Street 2:
Practice Address - City:OAK GROVE
Practice Address - State:LA
Practice Address - Zip Code:71263-7126
Practice Address - Country:US
Practice Address - Phone:318-537-6220
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-01
Last Update Date:2018-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA6359251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1386093078OtherDONATION