Provider Demographics
NPI:1487288833
Name:CROSSLEY, SHAWN M
Entity type:Individual
Prefix:
First Name:SHAWN
Middle Name:M
Last Name:CROSSLEY
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:419A MONROE RD
Mailing Address - Street 2:
Mailing Address - City:SARVER
Mailing Address - State:PA
Mailing Address - Zip Code:16055-9326
Mailing Address - Country:US
Mailing Address - Phone:724-388-6702
Mailing Address - Fax:
Practice Address - Street 1:419A MONROE RD
Practice Address - Street 2:
Practice Address - City:SARVER
Practice Address - State:PA
Practice Address - Zip Code:16055-9326
Practice Address - Country:US
Practice Address - Phone:724-388-6702
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-25
Last Update Date:2020-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC012061101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional