Provider Demographics
| NPI: | 1689923377 |
|---|---|
| Name: | CATALYST CROSSROADS, LLC |
| Entity Type: | Organization |
| Organization Name: | CATALYST CROSSROADS, LLC |
| Other - Org Name: | |
| Other - Org Type: | |
| Authorized Official - Title/Position: | PRESIDENT |
| Authorized Official - Prefix: | |
| Authorized Official - First Name: | RYAN |
| Authorized Official - Middle Name: | |
| Authorized Official - Last Name: | SMITH |
| Authorized Official - Suffix: | |
| Authorized Official - Credentials: | BA,CSMS,CNLP,CHHP |
| Authorized Official - Phone: | 412-760-4626 |
| Mailing Address - Street 1: | 461 COCHRAN RD |
| Mailing Address - Street 2: | #140 |
| Mailing Address - City: | MT LEBANON |
| Mailing Address - State: | PA |
| Mailing Address - Zip Code: | 15228-1253 |
| Mailing Address - Country: | US |
| Mailing Address - Phone: | 412-969-2733 |
| Mailing Address - Fax: | 412-774-2069 |
| Practice Address - Street 1: | 210 BOWER HILL RD |
| Practice Address - Street 2: | |
| Practice Address - City: | MT LEBANON |
| Practice Address - State: | PA |
| Practice Address - Zip Code: | 15228-1419 |
| Practice Address - Country: | US |
| Practice Address - Phone: | 412-760-4626 |
| Practice Address - Fax: | 412-774-2069 |
| EIN: | <UNAVAIL> |
| Is Organization Subpart?: | No |
| Parent Organization LBN: | |
| Parent Organization TIN: | |
| Enumeration Date: | 2012-09-10 |
| Last Update Date: | 2012-11-02 |
| Deactivation Date: | |
| Deactivation Code: | |
| Reactivation Date: |
Provider Licenses
| State | License ID | Taxonomies |
|---|---|---|
| 101YA0400X, 101YP1600X, 103K00000X, 133NN1002X, 172V00000X, 174400000X, 174H00000X, 175F00000X, 246Z00000X, 251B00000X, 374K00000X | ||
| PA | MSG00005670 | 225700000X |
| PA | PA-2279 | 225CA2400X, 225CA2500X |
| MD | PA-2279 | 225CA2400X |
Provider Taxonomies
| Primary? | Code | Type | Classification | Specialization | Group |
|---|---|---|---|---|---|
| Yes | 251B00000X | Agencies | Case Management | Group - Multi-Specialty | |
| No | 101YA0400X | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | Group - Multi-Specialty |
| No | 101YP1600X | Behavioral Health & Social Service Providers | Counselor | Pastoral | Group - Multi-Specialty |
| No | 103K00000X | Behavioral Health & Social Service Providers | Behavior Analyst | Group - Multi-Specialty | |
| No | 133NN1002X | Dietary & Nutritional Service Providers | Nutritionist | Nutrition, Education | Group - Multi-Specialty |
| No | 172V00000X | Other Service Providers | Community Health Worker | Group - Multi-Specialty | |
| No | 174400000X | Other Service Providers | Specialist | Group - Multi-Specialty | |
| No | 174H00000X | Other Service Providers | Health Educator | Group - Multi-Specialty | |
| No | 175F00000X | Other Service Providers | Naturopath | Group - Multi-Specialty | |
| No | 225700000X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Massage Therapist | Group - Multi-Specialty | |
| No | 225CA2400X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | Assistive Technology Practitioner | Group - Multi-Specialty |
| No | 225CA2500X | Respiratory, Developmental, Rehabilitative and Restorative Service Providers | Rehabilitation Counselor | Assistive Technology Supplier | Group - Multi-Specialty |
| No | 246Z00000X | Technologists, Technicians & Other Technical Service Providers | Specialist/Technologist, Other | Group - Multi-Specialty | |
| No | 374K00000X | Nursing Service Related Providers | Religious Nonmedical Practitioner | Group - Multi-Specialty |
Provider Identifiers
| State | Identifier ID | ID Type | Issuer |
|---|---|---|---|
| 1082811775 | Other | GLC CERTIFICATION BY SPENCER INSTITUTE(GREEN LIVING) | |
| PA | PA-2279 | Other | COGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC |
| PA | DC0234 | Other | BOARD CERTIFICATION- DISASTER CRISIS OUTREACH&REFERRAL PROF. (PA CERT. BOARD) |
| VA | PA-2279 | Other | COGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC |
| 70393001 | Other | BOARD CERTIFICATION AADP (AMERICAN ASSOCIATION OF DRUGLESS PRACTITIONERS) | |
| WV | PA-2279 | Other | COGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC |
| MD | PA-2279 | Other | COGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC |
| PA | MSG00005670 | Other | MASSAGE THERAPY LICENSE THROUGH PITTSBURGH SCHOOL OF MASSAGE |
| NP-001070 | Other | BOARD CERTIFICATION AIP (ASSOCIATION FOR INTEGRATIVE PSYCHOLOGY) | |
| AL011937 | Other | UNION CERTIFICATION BY HYPNOTHERAPISTS LOCAL NO. 472 | |
| OH | PA-2279 | Other | COGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC |
