Provider Demographics
NPI:1285112060
Name:CROSS CONNECTIONS, INC
Entity type:Organization
Organization Name:CROSS CONNECTIONS, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MATTHEW
Authorized Official - Middle Name:
Authorized Official - Last Name:KONOW
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:260-373-0213
Mailing Address - Street 1:4618 E STATE BLVD STE 300
Mailing Address - Street 2:
Mailing Address - City:FORT WAYNE
Mailing Address - State:IN
Mailing Address - Zip Code:46815-6966
Mailing Address - Country:US
Mailing Address - Phone:260-373-0213
Mailing Address - Fax:260-373-0218
Practice Address - Street 1:4618 E STATE BLVD STE 300
Practice Address - Street 2:
Practice Address - City:FORT WAYNE
Practice Address - State:IN
Practice Address - Zip Code:46815-6966
Practice Address - Country:US
Practice Address - Phone:260-373-0213
Practice Address - Fax:260-373-0218
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-02
Last Update Date:2018-08-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty