| Crosstown Counseling, Plc | |
|
5939 Portland Ave Minneapolis MN 55417-3127 | |
| (612) 866-6100 | |
| (612) 866-9379 |
| Full Name | Crosstown Counseling, Plc |
|---|---|
| Speciality | Counselor |
| Location | 5939 Portland Ave, Minneapolis, Minnesota |
| Authorized Official Name and Position | Mark W Smith (OWNER) |
| Authorized Official Contact | 6128666100 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Crosstown Counseling, Plc 5939 Portland Ave Minneapolis MN 55417-3127 Ph: (612) 866-6100 | Crosstown Counseling, Plc 5939 Portland Ave Minneapolis MN 55417-3127 Ph: (612) 866-6100 |
| NPI Number | 1356453211 |
|---|---|
| Provider Enumeration Date | 08/31/2006 |
| Last Update Date | 03/17/2018 |
| Medicare PECOS PAC ID | 7113983016 |
|---|---|
| Medicare Enrollment ID | O20041202000553 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1356453211 | NPI | - | NPPES |
| 102R3CR | Other | MN | BLUE CROSS BLUE SHIELD |
| 163639100 | Medicaid | MN |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 101YM0800X | Counselor - Mental Health | (Minnesota) | Primary |
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Secondary |
| Provider Name | Mark W Smith |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1508988908 PECOS PAC ID: 5294791109 Enrollment ID: I20041203000080 |
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