Provider Demographics
NPI:1417429226
Name:CROSSROADS PSYCHOLOGY CENTER, LLC
Entity Type:Organization
Organization Name:CROSSROADS PSYCHOLOGY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:VIKKI
Authorized Official - Middle Name:
Authorized Official - Last Name:TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:229-388-0932
Mailing Address - Street 1:PO BOX 2707
Mailing Address - Street 2:
Mailing Address - City:TIFTON
Mailing Address - State:GA
Mailing Address - Zip Code:31793-2707
Mailing Address - Country:US
Mailing Address - Phone:229-388-0932
Mailing Address - Fax:229-388-0933
Practice Address - Street 1:1017 CENTRAL AVE N
Practice Address - Street 2:
Practice Address - City:TIFTON
Practice Address - State:GA
Practice Address - Zip Code:31794-3967
Practice Address - Country:US
Practice Address - Phone:229-388-0932
Practice Address - Fax:229-388-0933
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty