Provider Demographics
NPI:1144429705
Name:CROSSROADS INTEGRATED HEALTH SERVICES, INC.
Entity Type:Organization
Organization Name:CROSSROADS INTEGRATED HEALTH SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER, THERAPIST
Authorized Official - Prefix:MRS
Authorized Official - First Name:KARAN
Authorized Official - Middle Name:E
Authorized Official - Last Name:GOINS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:423-581-5342
Mailing Address - Street 1:PO BOX 1678
Mailing Address - Street 2:
Mailing Address - City:MORRISTOWN
Mailing Address - State:TN
Mailing Address - Zip Code:37816-1678
Mailing Address - Country:US
Mailing Address - Phone:423-581-5342
Mailing Address - Fax:423-581-8650
Practice Address - Street 1:836 W 1ST NORTH ST
Practice Address - Street 2:
Practice Address - City:MORRISTOWN
Practice Address - State:TN
Practice Address - Zip Code:37814-4548
Practice Address - Country:US
Practice Address - Phone:423-581-5342
Practice Address - Fax:423-581-8650
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-13
Last Update Date:2014-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1644103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN3370113Medicare PIN