Provider Demographics
NPI:1710207303
Name:ALAN BROOKS CROSSROADS
Entity Type:Organization
Organization Name:ALAN BROOKS CROSSROADS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:ALAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BROOKS
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:801-337-0067
Mailing Address - Street 1:5150 S WASHINGTON BLVD STE 1
Mailing Address - Street 2:
Mailing Address - City:SOUTH OGDEN
Mailing Address - State:UT
Mailing Address - Zip Code:84405-4503
Mailing Address - Country:US
Mailing Address - Phone:801-337-0067
Mailing Address - Fax:801-337-0070
Practice Address - Street 1:5150 S WASHINGTON BLVD STE 1
Practice Address - Street 2:
Practice Address - City:SOUTH OGDEN
Practice Address - State:UT
Practice Address - Zip Code:84405-4503
Practice Address - Country:US
Practice Address - Phone:801-337-0067
Practice Address - Fax:801-337-0070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-06-04
Last Update Date:2010-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT15766251S00000X
UT15765253J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No253J00000XAgenciesFoster Care Agency