Provider Demographics
NPI:1720392137
Name:CROSSROADS CONSULTING CENTER
Entity Type:Organization
Organization Name:CROSSROADS CONSULTING CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:KEN
Authorized Official - Last Name:RIEDL
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:916-771-3707
Mailing Address - Street 1:2281 LAVA RIDGE CT
Mailing Address - Street 2:
Mailing Address - City:ROSEVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95661-2801
Mailing Address - Country:US
Mailing Address - Phone:916-771-3707
Mailing Address - Fax:916-771-3727
Practice Address - Street 1:2281 LAVA RIDGE CT
Practice Address - Street 2:
Practice Address - City:ROSEVILLE
Practice Address - State:CA
Practice Address - Zip Code:95661-2801
Practice Address - Country:US
Practice Address - Phone:916-771-3727
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-07-28
Last Update Date:2010-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CARO103211032251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health