Provider Demographics
NPI:1538568332
Name:CROSSROADS COUNSELING & CASE MANAGEMENT LLC
Entity type:Organization
Organization Name:CROSSROADS COUNSELING & CASE MANAGEMENT LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY CARE COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:DITTON
Authorized Official - Suffix:
Authorized Official - Credentials:BS PSY
Authorized Official - Phone:307-231-5738
Mailing Address - Street 1:PO BOX 267
Mailing Address - Street 2:
Mailing Address - City:BOULDER
Mailing Address - State:WY
Mailing Address - Zip Code:82923-0267
Mailing Address - Country:US
Mailing Address - Phone:307-231-5738
Mailing Address - Fax:
Practice Address - Street 1:798 S FREMONT
Practice Address - Street 2:
Practice Address - City:PINEDALE
Practice Address - State:WY
Practice Address - Zip Code:82941
Practice Address - Country:US
Practice Address - Phone:307-231-6853
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-08-18
Last Update Date:2014-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYFCC251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management