Organization
CROSSROAD THERAPY, LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
FRED MALESEVICH LCSW (OWNER)
(262) 777-1833
Entity
Organization
Contact information
Practice address
S110W30520 YMCA CAMP RD, MUKWONAGO, WI 53149-9534
(262) 777-1833
(262) 363-0973
Mailing address
S110W30520 YMCA CAMP RD, MUKWONAGO, WI 53149-9534
(262) 777-1833
(262) 363-0973
Taxonomy
Speciality
Code
Description
License number
State
1041C0700X
Clinical Social Worker
Primary
62-123
WI
Other
Enumeration date
08/10/2015
Last updated
08/10/2015
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