Healthcare Provider Details

I. General information

NPI: 1902916976
Provider Name (Legal Business Name): CROSSROADS COMMUNITY COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/30/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 QUINCY AVE SUITE 31
NAPERVILLE IL
60540-3955
US

IV. Provider business mailing address

1701 QUINCY AVE SUITE 31
NAPERVILLE IL
60540-3955
US

V. Phone/Fax

Practice location:
  • Phone: 630-428-1056
  • Fax: 630-428-1167
Mailing address:
  • Phone: 630-428-1056
  • Fax: 630-428-1167

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State

VIII. Authorized Official

Name: MICHAEL M MURPHY
Title or Position: PASTOR
Credential:
Phone: 630-428-1056