Provider Demographics
NPI:1972758472
Name:CROSSROADS COUNSELING CENTER LLC
Entity Type:Organization
Organization Name:CROSSROADS COUNSELING CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JAMES
Authorized Official - Middle Name:OLIVER
Authorized Official - Last Name:BROWN
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:865-286-5637
Mailing Address - Street 1:1016 DOLLY PARTON PKWY
Mailing Address - Street 2:SUITE 9
Mailing Address - City:SEVIERVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37862-3740
Mailing Address - Country:US
Mailing Address - Phone:865-286-5637
Mailing Address - Fax:865-286-5665
Practice Address - Street 1:1016 DOLLY PARTON PKWY
Practice Address - Street 2:SUITE 9
Practice Address - City:SEVIERVILLE
Practice Address - State:TN
Practice Address - Zip Code:37862-3740
Practice Address - Country:US
Practice Address - Phone:865-286-5637
Practice Address - Fax:865-286-5665
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-11-25
Last Update Date:2008-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN2406101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty