Provider Demographics
NPI:1225574072
Name:CROSSPOINT COMMUNITY COUNSELING LLC
Entity type:Organization
Organization Name:CROSSPOINT COMMUNITY COUNSELING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER/THERAPIST
Authorized Official - Prefix:MR
Authorized Official - First Name:MERLE
Authorized Official - Middle Name:
Authorized Official - Last Name:BROCK
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:918-615-3435
Mailing Address - Street 1:3101 N HEMLOCK CIR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:BROKEN ARROW
Mailing Address - State:OK
Mailing Address - Zip Code:74012-1103
Mailing Address - Country:US
Mailing Address - Phone:918-615-3435
Mailing Address - Fax:918-615-3436
Practice Address - Street 1:3101 N HEMLOCK CIR
Practice Address - Street 2:SUITE 100
Practice Address - City:BROKEN ARROW
Practice Address - State:OK
Practice Address - Zip Code:74012-1103
Practice Address - Country:US
Practice Address - Phone:918-615-3435
Practice Address - Fax:918-615-3436
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-01-17
Last Update Date:2024-02-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106H00000X
OK251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1689854259OtherTYPE I NPI
12455199OtherCAQH