Provider Demographics
NPI:1346790375
Name:CROSSROADS PSYCHOLOGICAL CENTER PLLC
Entity type:Organization
Organization Name:CROSSROADS PSYCHOLOGICAL CENTER PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:DEBRA
Authorized Official - Middle Name:
Authorized Official - Last Name:HAMILTON
Authorized Official - Suffix:
Authorized Official - Credentials:PSYD, LLP
Authorized Official - Phone:989-709-5430
Mailing Address - Street 1:106 N ANTLER ST
Mailing Address - Street 2:
Mailing Address - City:GLADWIN
Mailing Address - State:MI
Mailing Address - Zip Code:48624-1562
Mailing Address - Country:US
Mailing Address - Phone:989-709-5430
Mailing Address - Fax:989-403-7161
Practice Address - Street 1:106 N ANTLER ST
Practice Address - Street 2:
Practice Address - City:GLADWIN
Practice Address - State:MI
Practice Address - Zip Code:48624-1562
Practice Address - Country:US
Practice Address - Phone:989-709-5430
Practice Address - Fax:989-403-7161
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-10-13
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261QM0850X
MI6301015668261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health