1154381671 NPI number — CROSSROADS FAMILY COUNSELING CENTER, LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1154381671 NPI number — CROSSROADS FAMILY COUNSELING CENTER, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CROSSROADS FAMILY COUNSELING CENTER, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1154381671
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/04/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
39737 N HIGH NOON WAY
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ANTHEM
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
85086-2376
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
623-551-9234
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4614 E SHEA BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
PHOENIX
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
85028-3081
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
602-316-7134
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/27/2006

Additional Information

Authorized Official

Authorized Official Last Name:
FRYE
Authorized Official First Name:
TRAVIS
Authorized Official Middle Name:
EUGENE
Authorized Official Title or Position:
OWNER AND FOUNDER
Authorized Official Telephone Number:
623-680-3486

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC-12149 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





Copyright © 2007-2025 www.npivalidator.com