Provider Demographics
NPI:1215791009
Name:CROSSROADS HAVEN COUNSELING LLC
Entity type:Organization
Organization Name:CROSSROADS HAVEN COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHONY
Authorized Official - Middle Name:
Authorized Official - Last Name:SUNG
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:816-301-4238
Mailing Address - Street 1:5000 W 95TH ST STE 285
Mailing Address - Street 2:
Mailing Address - City:PRAIRIE VILLAGE
Mailing Address - State:KS
Mailing Address - Zip Code:66207-3363
Mailing Address - Country:US
Mailing Address - Phone:816-301-4238
Mailing Address - Fax:913-222-1880
Practice Address - Street 1:5000 W 95TH ST STE 285
Practice Address - Street 2:
Practice Address - City:PRAIRIE VILLAGE
Practice Address - State:KS
Practice Address - Zip Code:66207-3363
Practice Address - Country:US
Practice Address - Phone:816-301-4238
Practice Address - Fax:913-222-1880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-12
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty