Provider Demographics
NPI:1588654701
Name:SUBURBAN CROSSROADS COUNSELING
Entity Type:Organization
Organization Name:SUBURBAN CROSSROADS COUNSELING
Other - Org Name:SUBURBAN PASTORAL COUNSELING CLINIC, INC.
Other - Org Type:Other Name
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TYLER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:HOWARD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:979-450-9375
Mailing Address - Street 1:PO BOX 3274
Mailing Address - Street 2:
Mailing Address - City:CATONSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21228-0274
Mailing Address - Country:US
Mailing Address - Phone:410-775-8233
Mailing Address - Fax:
Practice Address - Street 1:1 N BEECHWOOD AVE
Practice Address - Street 2:
Practice Address - City:CATONSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21228-4926
Practice Address - Country:US
Practice Address - Phone:410-775-8233
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-27
Last Update Date:2024-04-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
MDLC1801101YP2500X, 101YP2500X
MD13411104100000X, 104100000X
MDR072594364SP0809X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No104100000XBehavioral Health & Social Service ProvidersSocial WorkerGroup - Multi-Specialty
No364SP0809XPhysician Assistants & Advanced Practice Nursing ProvidersClinical Nurse SpecialistPsychiatric/Mental Health, AdultGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDQR62SUOtherCAREFIRST MD
MDR039OtherCAREFIRST FEDERAL
MD104796500Medicaid