Provider Demographics
NPI:1891851960
Name:CROSSROADS PSYCHOTHERAPY CENTRE, PC
Entity Type:Organization
Organization Name:CROSSROADS PSYCHOTHERAPY CENTRE, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER PSYCHOTHERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:FAITH
Authorized Official - Middle Name:A
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMHP,LPC
Authorized Official - Phone:402-489-8484
Mailing Address - Street 1:5625 O ST
Mailing Address - Street 2:SUITE 7
Mailing Address - City:LINCOLN
Mailing Address - State:NE
Mailing Address - Zip Code:68510-2196
Mailing Address - Country:US
Mailing Address - Phone:402-489-8484
Mailing Address - Fax:402-441-0664
Practice Address - Street 1:5625 O ST
Practice Address - Street 2:SUITE 7
Practice Address - City:LINCOLN
Practice Address - State:NE
Practice Address - Zip Code:68510-2196
Practice Address - Country:US
Practice Address - Phone:402-489-8484
Practice Address - Fax:402-441-0664
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-31
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE2316101YM0800X
NE1286101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE=========26Medicaid