Basic Information
| Provider Information | |||||||||
| NPI: | 1134621691 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | CROSSINGS CHRISTIAN COUNSELING | ||||||||
| LastName: | |||||||||
| FirstName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | TRINITY BAPTIST CHURCH | ||||||||
| OtherOrganizationType: | 5 | ||||||||
| OtherLastName: | |||||||||
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| Mailing Information | |||||||||
| Address1: | 7099 HIGHWAY 2 | ||||||||
| Address2: | |||||||||
| City: | OAK GROVE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712638392 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185376220 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 1002 WEST MAIN | ||||||||
| Address2: | |||||||||
| City: | OAK GROVE | ||||||||
| State: | LA | ||||||||
| PostalCode: | 712637126 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3185376220 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/01/2018 | ||||||||
| LastUpdateDate: | 03/01/2018 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | BULLOCK | ||||||||
| AuthorizedOfficialFirstName: | PATRICIA | ||||||||
| AuthorizedOfficialMiddleName: | TAMMETTE | ||||||||
| AuthorizedOfficialTitleorPosition: | COUNSELOR | ||||||||
| AuthorizedOfficialTelephone: | 3185376220 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | LPC | ||||||||
| NPICertificationDate: | |||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251S00000X | 6359 | LA | Y | Agencies | Community/Behavioral Health |
ID Information
| ID | Type | State | Issuer | Description | 1386093078 | 01 | LA | DONATION | OTHER |