NPIMap

Organization Active NPI

Crossroads Treatment Center, Inc.

  • Addiction (Substance Use Disorder) Counselor
  • Lakewood, WA
National Provider Identifier
1417397951
Registry record updated Jun 28, 2013
On this page

Key facts

NPPES NPI Registry
Primary specialty
Addiction (Substance Use Disorder) CounselorTaxonomy code 101YA0400X
License
CO60367121 Issued in WA
Legal business name
CROSSROADS TREATMENT CENTER, INC.
Practice address
10828 Gravelly Lake Dr SW Ste 204
Lakewood, WA 98499-1346
Phone
(253) 473-7474
Fax
(253) 474-9724
NPI assigned
Jun 28, 2013
Last updated
Jun 28, 2013By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2013

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Mr. Kelley Nelson Whitty-Sandaker, CDPT
Title
CDPT Intern
Phone
(850) 218-0752

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Counselor 101YA0400X CO60367121 WA Primary

Addresses

Primary practice location

10828 Gravelly Lake Dr SW Ste 204
Lakewood, WA 98499-1346

Mailing address

10828 Gravelly Lake Dr SW Ste 204
Lakewood, WA 98499-1346
Phone (253) 473-7474

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 7

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1372377600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1372377600000",
    "number": "1417397951",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10828 GRAVELLY LAKE DR SW STE 204",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984991346",
            "telephone_number": "253-473-7474",
            "fax_number": "253-474-9724"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10828 GRAVELLY LAKE DR SW STE 204",
            "city": "LAKEWOOD",
            "state": "WA",
            "postal_code": "984991346",
            "telephone_number": "253-473-7474",
            "fax_number": "253-474-9724"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS TREATMENT CENTER, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2013-06-28",
        "last_updated": "2013-06-28",
        "status": "A",
        "authorized_official_last_name": "WHITTY-SANDAKER",
        "authorized_official_first_name": "KELLEY",
        "authorized_official_middle_name": "NELSON",
        "authorized_official_title_or_position": "CDPT INTERN",
        "authorized_official_telephone_number": "850-218-0752",
        "authorized_official_name_prefix": "Mr.",
        "authorized_official_credential": "CDPT"
    },
    "taxonomies": [
        {
            "code": "101YA0400X",
            "taxonomy_group": "",
            "desc": "Counselor, Addiction (Substance Use Disorder)",
            "state": "WA",
            "license": "CO60367121",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Lakewood, WA

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2013; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.