Provider Demographics
NPI:1417503723
Name:BEYOND THE CROSSROADS COUNSELING CENTER, LLC
Entity Type:Organization
Organization Name:BEYOND THE CROSSROADS COUNSELING CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:VERONICA
Authorized Official - Middle Name:
Authorized Official - Last Name:TRAHAN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:318-219-4100
Mailing Address - Street 1:3321 YOUREE DR STE E
Mailing Address - Street 2:
Mailing Address - City:SHREVEPORT
Mailing Address - State:LA
Mailing Address - Zip Code:71105-2123
Mailing Address - Country:US
Mailing Address - Phone:318-219-4100
Mailing Address - Fax:318-219-4108
Practice Address - Street 1:3321 YOUREE DR STE E
Practice Address - Street 2:
Practice Address - City:SHREVEPORT
Practice Address - State:LA
Practice Address - Zip Code:71105-2123
Practice Address - Country:US
Practice Address - Phone:318-219-4100
Practice Address - Fax:318-219-4108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-13
Last Update Date:2019-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health