Provider Demographics
NPI:1467409516
Name:CROSSROADS PSYCHOTHERAPY GROUP INC.
Entity Type:Organization
Organization Name:CROSSROADS PSYCHOTHERAPY GROUP INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/ CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBORAH
Authorized Official - Middle Name:G
Authorized Official - Last Name:MATHER
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:714-846-8230
Mailing Address - Street 1:16033 BOLSA CHICA ST
Mailing Address - Street 2:SUITE #104-239
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92649-2452
Mailing Address - Country:US
Mailing Address - Phone:714-846-8230
Mailing Address - Fax:714-840-6508
Practice Address - Street 1:6615 E PACIFIC COAST HWY
Practice Address - Street 2:SUITE #115
Practice Address - City:LONG BEACH
Practice Address - State:CA
Practice Address - Zip Code:90803-4211
Practice Address - Country:US
Practice Address - Phone:562-596-0090
Practice Address - Fax:562-596-0094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-27
Last Update Date:2013-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAW18896Medicare ID - Type Unspecified
CAW18896AMedicare ID - Type Unspecified