Provider Demographics
NPI:1003347287
Name:CROSSROADS COUNSELING
Entity Type:Organization
Organization Name:CROSSROADS COUNSELING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:MIRYAM
Authorized Official - Middle Name:NOEMI
Authorized Official - Last Name:MEJIA
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:831-240-8728
Mailing Address - Street 1:801 LIGHTHOUSE AVE
Mailing Address - Street 2:212
Mailing Address - City:MONTEREY
Mailing Address - State:CA
Mailing Address - Zip Code:93940-1046
Mailing Address - Country:US
Mailing Address - Phone:831-240-8728
Mailing Address - Fax:
Practice Address - Street 1:801 LIGHTHOUSE AVE
Practice Address - Street 2:212
Practice Address - City:MONTEREY
Practice Address - State:CA
Practice Address - Zip Code:93940-1046
Practice Address - Country:US
Practice Address - Phone:831-240-8728
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-21
Last Update Date:2017-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA51905261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health