Organization
CROSSTOWN COUNSELING, PLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MARK W SMITH LICSW (OWNER)
(612) 866-6100
Entity
Organization
Contact information
Practice address
5939 PORTLAND AVE, MINNEAPOLIS, MN 55417-3127
(612) 866-6100
(612) 866-9379
Mailing address
5939 PORTLAND AVE, MINNEAPOLIS, MN 55417-3127
(612) 866-6100
(612) 866-9379
Taxonomy
Speciality
Code
Description
License number
State
101YM0800X
Mental Health Counselor
Primary
—
MN
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
01
—
102R3CR
BLUE CROSS BLUE SHIELD
MN
05
—
163639100
—
MN
Enumeration date
08/31/2006
Last updated
03/17/2018
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