Provider Demographics
NPI:1598912792
Name:WYLIE JAMES BAGLEY
Entity Type:Organization
Organization Name:WYLIE JAMES BAGLEY
Other - Org Name:CROSSROADS COUNSELING & RESEARCH
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LMFT
Authorized Official - Prefix:MR
Authorized Official - First Name:WYLIE
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:BAGLEY
Authorized Official - Suffix:
Authorized Official - Credentials:MA
Authorized Official - Phone:318-791-1555
Mailing Address - Street 1:224 HENDERSON RD
Mailing Address - Street 2:
Mailing Address - City:WEST MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71291-9409
Mailing Address - Country:US
Mailing Address - Phone:318-791-1555
Mailing Address - Fax:318-343-3851
Practice Address - Street 1:108 FILHIOL AVE
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71203-3828
Practice Address - Country:US
Practice Address - Phone:318-791-1555
Practice Address - Fax:318-343-3851
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-08-19
Last Update Date:2008-08-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1016106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty