Provider Demographics
NPI:1740497338
Name:CROSNO FAMILY PSYCHOLOGY CLINIC LLC
Entity type:Organization
Organization Name:CROSNO FAMILY PSYCHOLOGY CLINIC LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:CRYSTAL
Authorized Official - Middle Name:D
Authorized Official - Last Name:RHOADS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:281-361-0777
Mailing Address - Street 1:4439 TOWN CENTER PL
Mailing Address - Street 2:
Mailing Address - City:KINGWOOD
Mailing Address - State:TX
Mailing Address - Zip Code:77339-3714
Mailing Address - Country:US
Mailing Address - Phone:281-361-0777
Mailing Address - Fax:281-361-5777
Practice Address - Street 1:4439 TOWN CENTER PL
Practice Address - Street 2:
Practice Address - City:KINGWOOD
Practice Address - State:TX
Practice Address - Zip Code:77339-3714
Practice Address - Country:US
Practice Address - Phone:281-361-0777
Practice Address - Fax:281-361-5777
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-16
Last Update Date:2010-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX79MSOtherGROUP NUMBER FOR BCBS