Organization
CROSSROADS COUNSELING AND PLAY CENTER, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
TRACY O GARDNER LPC (OWNER)
(662) 396-1176
Entity
Organization
Contact information
Practice address
401 E WALDRON ST STE B, CORINTH, MS 38834-4707
(662) 396-1167
(662) 260-7106
Mailing address
2040 E SHILOH RD STE 1, CORINTH, MS 38834-3725
Taxonomy
Speciality
Code
Description
License number
State
101YP2500X
Professional Counselor
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
801096466
LICENSE
MS
Enumeration date
07/31/2019
Last updated
12/04/2019
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