Provider Demographics
NPI:1497134738
Name:CARRARA-HAY COUNSELING, P.C.
Entity Type:Organization
Organization Name:CARRARA-HAY COUNSELING, P.C.
Other - Org Name:CROSSROADS COUNSELING SOLUTIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:MARIANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:CARRARA-HAY
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:217-586-9999
Mailing Address - Street 1:110 S LOMBARD ST
Mailing Address - Street 2:
Mailing Address - City:MAHOMET
Mailing Address - State:IL
Mailing Address - Zip Code:61853-9202
Mailing Address - Country:US
Mailing Address - Phone:217-586-9999
Mailing Address - Fax:217-590-0174
Practice Address - Street 1:110 S LOMBARD ST
Practice Address - Street 2:
Practice Address - City:MAHOMET
Practice Address - State:IL
Practice Address - Zip Code:61853-9202
Practice Address - Country:US
Practice Address - Phone:217-586-9999
Practice Address - Fax:217-590-0174
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-19
Last Update Date:2015-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL149008892261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)