Provider Demographics
NPI:1386290724
Name:ALLEGIANCE RESILIENCY THERAPY L.L.C.
Entity type:Organization
Organization Name:ALLEGIANCE RESILIENCY THERAPY L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:PATRICIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:MS, LMHC
Authorized Official - Phone:850-238-7131
Mailing Address - Street 1:550 N MAIN ST STE A
Mailing Address - Street 2:
Mailing Address - City:CRESTVIEW
Mailing Address - State:FL
Mailing Address - Zip Code:32536-3506
Mailing Address - Country:US
Mailing Address - Phone:850-238-7131
Mailing Address - Fax:
Practice Address - Street 1:550 N MAIN ST STE A
Practice Address - Street 2:
Practice Address - City:CRESTVIEW
Practice Address - State:FL
Practice Address - Zip Code:32536-3506
Practice Address - Country:US
Practice Address - Phone:850-238-7131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-12
Last Update Date:2022-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health