Provider Demographics
NPI:1831432806
Name:CROSSROADS INSTITUTE FOR PSYCHOTHERAPY AND ASSESSMENT, INC
Entity type:Organization
Organization Name:CROSSROADS INSTITUTE FOR PSYCHOTHERAPY AND ASSESSMENT, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:SONI
Authorized Official - Middle Name:KIM
Authorized Official - Last Name:MONROE
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD
Authorized Official - Phone:424-201-1600
Mailing Address - Street 1:2601 AIRPORT DR
Mailing Address - Street 2:SUITE 135
Mailing Address - City:TORRANCE
Mailing Address - State:CA
Mailing Address - Zip Code:90505-6140
Mailing Address - Country:US
Mailing Address - Phone:424-201-1600
Mailing Address - Fax:424-201-1601
Practice Address - Street 1:2601 AIRPORT DR
Practice Address - Street 2:SUITE 135
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-6140
Practice Address - Country:US
Practice Address - Phone:424-201-1600
Practice Address - Fax:424-201-1601
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-28
Last Update Date:2016-08-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & AdolescentGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
CACB239646Medicare PIN
CACB222844Medicare PIN