MEDICARE: CROSSROADS COUNSELING SERVICES LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	394	AL

General Provider Information

NPI Number	:	1033500335
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS COUNSELING SERVICES LLC

Provider Business Mailing Address
First Line	:	1528 SOUTHERN DR
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-3524
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4887 VALLEYDALE RD
Second Line	:
City	:	BIRMINGHAM
State	:	AL
Zip	:	35242-4612
Country	:	US
Telephone Number	:	205-995-9673
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	MARJORIE P SLAUGHTER
Credential	:
Telephone Number	:	205-535-1123

Provider Enumeration Date	:	02/09/2015
Last Update Date	:	02/09/2015

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