| Crossroad Therapy, Llc | |
|
S110w30520 Ymca Camp Rd Mukwonago WI 53149-9534 | |
| (262) 777-1833 | |
| (262) 363-0973 |
| Full Name | Crossroad Therapy, Llc |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | S110w30520 Ymca Camp Rd, Mukwonago, Wisconsin |
| Authorized Official Name and Position | Fred Malesevich (OWNER) |
| Authorized Official Contact | 2627771833 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Crossroad Therapy, Llc S110w30520 Ymca Camp Rd Mukwonago WI 53149-9534 Ph: (262) 777-1833 | Crossroad Therapy, Llc S110w30520 Ymca Camp Rd Mukwonago WI 53149-9534 Ph: (262) 777-1833 |
| NPI Number | 1790161016 |
|---|---|
| Provider Enumeration Date | 08/10/2015 |
| Last Update Date | 08/10/2015 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790161016 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | 62-123 (Wisconsin) | Primary |
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