Provider Demographics
NPI:1528614229
Name:CROSSROADS BEHAVIORAL HEALTH PROVIDERS
Entity type:Organization
Organization Name:CROSSROADS BEHAVIORAL HEALTH PROVIDERS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:
Authorized Official - First Name:SHAZIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MAHMOOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:270-300-5564
Mailing Address - Street 1:PO BOX 305
Mailing Address - Street 2:
Mailing Address - City:UNION CITY
Mailing Address - State:IN
Mailing Address - Zip Code:47390-0305
Mailing Address - Country:US
Mailing Address - Phone:765-969-7841
Mailing Address - Fax:
Practice Address - Street 1:1900 MEDICAL ARTS DR
Practice Address - Street 2:
Practice Address - City:HUNTINGBURG
Practice Address - State:IN
Practice Address - Zip Code:47542-9821
Practice Address - Country:US
Practice Address - Phone:270-900-1461
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-08-18
Last Update Date:2019-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Multi-Specialty
No207Q00000XAllopathic & Osteopathic PhysiciansFamily MedicineGroup - Multi-Specialty