Organization
CROSSROADS 1010 LLC
Active
Organization
CROSSROADS 1010 LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
JENNIFER GRIFFIN LPC (OWNER)
(580) 317-7002
Entity
Organization
Contact information
Practice address
193908 US HWY 271, ANTLERS, OK 74523
(580) 271-7080
(580) 298-2081
Mailing address
P.O. BO 1012, ANTLERS, OK 74523
(580) 271-7080
(580) 298-2081
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
Primary
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
200734990A
—
OK
Enumeration date
09/27/2016
Last updated
11/27/2018
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