Basic Information
| Provider Information | |||||||||
| NPI: | 1831432806 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | CROSSROADS INSTITUTE FOR PSYCHOTHERAPY AND ASSESSMENT, INC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 2601 AIRPORT DR | ||||||||
| Address2: | SUITE 135 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905056140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4242011600 | ||||||||
| FaxNumber: | 4242011601 | ||||||||
| Practice Location | |||||||||
| Address1: | 2601 AIRPORT DR | ||||||||
| Address2: | SUITE 135 | ||||||||
| City: | TORRANCE | ||||||||
| State: | CA | ||||||||
| PostalCode: | 905056140 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 4242011600 | ||||||||
| FaxNumber: | 4242011601 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/28/2013 | ||||||||
| LastUpdateDate: | 08/23/2016 | ||||||||
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| AuthorizedOfficialLastName: | MONROE | ||||||||
| AuthorizedOfficialFirstName: | SONI | ||||||||
| AuthorizedOfficialMiddleName: | KIM | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 4242011600 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | PSY.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103TC2200X | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical Child & Adolescent | 103TC0700X | Y | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Psychologist | Clinical |
No ID Information.