Healthcare Provider Details

I. General information

NPI: 1831432806
Provider Name (Legal Business Name): CROSSROADS INSTITUTE FOR PSYCHOTHERAPY AND ASSESSMENT, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2013
Last Update Date: 08/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 AIRPORT DR SUITE 135
TORRANCE CA
90505-6140
US

IV. Provider business mailing address

2601 AIRPORT DR SUITE 135
TORRANCE CA
90505-6140
US

V. Phone/Fax

Practice location:
  • Phone: 424-201-1600
  • Fax: 424-201-1601
Mailing address:
  • Phone: 424-201-1600
  • Fax: 424-201-1601

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number
License Number State

VIII. Authorized Official

Name: SONI KIM MONROE
Title or Position: PRESIDENT
Credential: PSY.D.
Phone: 424-201-1600