Provider Demographics
NPI:1689923377
Name:CATALYST CROSSROADS, LLC
Entity type:Organization
Organization Name:CATALYST CROSSROADS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RYAN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:BA,CSMS,CNLP,CHHP
Authorized Official - Phone:412-760-4626
Mailing Address - Street 1:461 COCHRAN RD
Mailing Address - Street 2:#140
Mailing Address - City:MT LEBANON
Mailing Address - State:PA
Mailing Address - Zip Code:15228-1253
Mailing Address - Country:US
Mailing Address - Phone:412-969-2733
Mailing Address - Fax:412-774-2069
Practice Address - Street 1:210 BOWER HILL RD
Practice Address - Street 2:
Practice Address - City:MT LEBANON
Practice Address - State:PA
Practice Address - Zip Code:15228-1419
Practice Address - Country:US
Practice Address - Phone:412-760-4626
Practice Address - Fax:412-774-2069
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-09-10
Last Update Date:2012-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 101YP1600X, 103K00000X, 133NN1002X, 172V00000X, 174400000X, 174H00000X, 175F00000X, 246Z00000X, 251B00000X, 374K00000X
PAMSG00005670225700000X
PAPA-2279225CA2400X, 225CA2500X
MDPA-2279225CA2400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251B00000XAgenciesCase ManagementGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoralGroup - Multi-Specialty
No103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Multi-Specialty
No133NN1002XDietary & Nutritional Service ProvidersNutritionistNutrition, EducationGroup - Multi-Specialty
No172V00000XOther Service ProvidersCommunity Health WorkerGroup - Multi-Specialty
No174400000XOther Service ProvidersSpecialistGroup - Multi-Specialty
No174H00000XOther Service ProvidersHealth EducatorGroup - Multi-Specialty
No175F00000XOther Service ProvidersNaturopathGroup - Multi-Specialty
No225700000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersMassage TherapistGroup - Multi-Specialty
No225CA2400XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology PractitionerGroup - Multi-Specialty
No225CA2500XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersRehabilitation CounselorAssistive Technology SupplierGroup - Multi-Specialty
No246Z00000XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherGroup - Multi-Specialty
No374K00000XNursing Service Related ProvidersReligious Nonmedical PractitionerGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
1082811775OtherGLC CERTIFICATION BY SPENCER INSTITUTE(GREEN LIVING)
PAPA-2279OtherCOGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC
PADC0234OtherBOARD CERTIFICATION- DISASTER CRISIS OUTREACH&REFERRAL PROF. (PA CERT. BOARD)
VAPA-2279OtherCOGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC
70393001OtherBOARD CERTIFICATION AADP (AMERICAN ASSOCIATION OF DRUGLESS PRACTITIONERS)
WVPA-2279OtherCOGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC
MDPA-2279OtherCOGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC
PAMSG00005670OtherMASSAGE THERAPY LICENSE THROUGH PITTSBURGH SCHOOL OF MASSAGE
NP-001070OtherBOARD CERTIFICATION AIP (ASSOCIATION FOR INTEGRATIVE PSYCHOLOGY)
AL011937OtherUNION CERTIFICATION BY HYPNOTHERAPISTS LOCAL NO. 472
OHPA-2279OtherCOGNITIVE TRAINING SPECIALIST THROUGH UNIQUE LOGIC & TECHNOLOGY, INC