Provider Demographics
NPI:1104198209
Name:CROSS COUSELING & BEHAVIORAL HEALTH
Entity type:Organization
Organization Name:CROSS COUSELING & BEHAVIORAL HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:A
Authorized Official - Last Name:MILLS
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:314-323-3853
Mailing Address - Street 1:1385 CREECH SCHOOL RD
Mailing Address - Street 2:
Mailing Address - City:TROY
Mailing Address - State:MO
Mailing Address - Zip Code:63379-5373
Mailing Address - Country:US
Mailing Address - Phone:314-323-3853
Mailing Address - Fax:636-462-5357
Practice Address - Street 1:1385 CREECH SCHOOL RD
Practice Address - Street 2:
Practice Address - City:TROY
Practice Address - State:MO
Practice Address - Zip Code:63379-5373
Practice Address - Country:US
Practice Address - Phone:314-323-3853
Practice Address - Fax:636-462-5357
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-02-03
Last Update Date:2012-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2010025391251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health