Provider Demographics
NPI:1346790375
Name:CROSSROADS PSYCHOLOGICAL CENTER PLLC
Entity Type:Organization
Organization Name:CROSSROADS PSYCHOLOGICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:TLLP
Authorized Official - Phone:989-860-9545
Mailing Address - Street 1:7805 COOLEY LAKE RD
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WEST BLOOMFIELD
Mailing Address - State:MI
Mailing Address - Zip Code:48324-3537
Mailing Address - Country:US
Mailing Address - Phone:248-301-5585
Mailing Address - Fax:
Practice Address - Street 1:7805 COOLEY LAKE RD
Practice Address - Street 2:SUITE 300
Practice Address - City:WEST BLOOMFIELD
Practice Address - State:MI
Practice Address - Zip Code:48324-3537
Practice Address - Country:US
Practice Address - Phone:248-301-5585
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2017-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6301015668251S00000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No251S00000XAgenciesCommunity/Behavioral Health