Healthcare Provider Details

I. General information

NPI: 1861542334
Provider Name (Legal Business Name): CROSSMONT & ASSOCIATES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/10/2007
Last Update Date: 06/02/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10522 S CICERO AVE SUITE 302
OAK LAWN IL
60453-5200
US

IV. Provider business mailing address

10522 S CICERO AVE SUITE 302
OAK LAWN IL
60453-5200
US

V. Phone/Fax

Practice location:
  • Phone: 708-229-0700
  • Fax: 708-229-0173
Mailing address:
  • Phone: 708-229-0700
  • Fax: 708-229-0173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License NumberA-1545-0001-A
License Number StateIL
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberA-1545-0001-A
License Number StateIL
# 3
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberA-1545-0001-A
License Number StateIL

VIII. Authorized Official

Name: DR. EDNA R CROSS
Title or Position: PRESIDENT
Credential: PHD
Phone: 708-229-0700