Provider Demographics
NPI:1053712034
Name:CROSSROADS COUNSELING, PLLC
Entity type:Organization
Organization Name:CROSSROADS COUNSELING, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:DIANE
Authorized Official - Middle Name:
Authorized Official - Last Name:BACHMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:801-725-2095
Mailing Address - Street 1:137 E 1600 S
Mailing Address - Street 2:
Mailing Address - City:FARMINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84025-2047
Mailing Address - Country:US
Mailing Address - Phone:801-756-7200
Mailing Address - Fax:801-756-6641
Practice Address - Street 1:190 S MAIN ST
Practice Address - Street 2:STE 100
Practice Address - City:CENTERVILLE
Practice Address - State:UT
Practice Address - Zip Code:84014-2814
Practice Address - Country:US
Practice Address - Phone:801-725-2095
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-10
Last Update Date:2015-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT8332548-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty