Provider Demographics
NPI:1255593315
Name:CROSSROADS COUNSELING AND LIFE COACHING LLC
Entity type:Organization
Organization Name:CROSSROADS COUNSELING AND LIFE COACHING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:
Authorized Official - First Name:REBECCA
Authorized Official - Middle Name:S
Authorized Official - Last Name:MOWERS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:309-343-0800
Mailing Address - Street 1:575 N KELLOGG ST
Mailing Address - Street 2:SUITE 4
Mailing Address - City:GALESBURG
Mailing Address - State:IL
Mailing Address - Zip Code:61401-7608
Mailing Address - Country:US
Mailing Address - Phone:309-343-0800
Mailing Address - Fax:309-343-0802
Practice Address - Street 1:575 N KELLOGG ST
Practice Address - Street 2:SUITE 4
Practice Address - City:GALESBURG
Practice Address - State:IL
Practice Address - Zip Code:61401-7608
Practice Address - Country:US
Practice Address - Phone:309-343-0800
Practice Address - Fax:309-343-0802
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2016-10-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178-004809101YM0800X
IL149.0130631041C0700X
IL180007544101YP2500X
IL071.005306103TC0700X
IL180008809101YM0800X
IL178011327101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty