Provider Demographics
NPI:1194122275
Name:CROSSWAY COUNSLING LLC
Entity type:Organization
Organization Name:CROSSWAY COUNSLING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE ASSISTANT
Authorized Official - Prefix:MRS
Authorized Official - First Name:KIMBERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:GILBERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:580-371-9933
Mailing Address - Street 1:9420 SOUTH RED MAN RD.
Mailing Address - Street 2:
Mailing Address - City:RAVIA
Mailing Address - State:OK
Mailing Address - Zip Code:73455
Mailing Address - Country:US
Mailing Address - Phone:580-371-7328
Mailing Address - Fax:
Practice Address - Street 1:9420 SOUTH RED MAN RD.
Practice Address - Street 2:
Practice Address - City:RAVIA
Practice Address - State:OK
Practice Address - Zip Code:73455
Practice Address - Country:US
Practice Address - Phone:580-371-7328
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-12-04
Last Update Date:2014-12-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management
Provider Identifiers
StateIdentifier IDID TypeIssuer
0000000OtherMEDICADE AND MEDICARE