Provider Demographics
NPI:1184434680
Name:CROSLAND BEHAVIORAL HEALTH CARE, LLC
Entity type:Organization
Organization Name:CROSLAND BEHAVIORAL HEALTH CARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER, PRESIDENT, CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:DARWIN
Authorized Official - Middle Name:PHIL
Authorized Official - Last Name:CROSLAND
Authorized Official - Suffix:
Authorized Official - Credentials:MC/MHC, LCMHC,
Authorized Official - Phone:801-989-4873
Mailing Address - Street 1:2733 S BLUFF RD.
Mailing Address - Street 2:
Mailing Address - City:SYRACUSE
Mailing Address - State:UT
Mailing Address - Zip Code:84075-8924
Mailing Address - Country:US
Mailing Address - Phone:801-989-4873
Mailing Address - Fax:
Practice Address - Street 1:2733 S BLUFF RD.
Practice Address - Street 2:
Practice Address - City:SYRACUSE
Practice Address - State:UT
Practice Address - Zip Code:84075-8924
Practice Address - Country:US
Practice Address - Phone:801-989-4873
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-01-08
Last Update Date:2025-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Multi-Specialty
No103TF0200XBehavioral Health & Social Service ProvidersPsychologistForensicGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT88539717Medicaid