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General NPI Number Information
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NPI Number | 1346790375
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Entity Type | Organization
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Legal Business Name | CROSSROADS PSYCHOLOGICAL CENTER PLLC
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Dates
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Enumeration Date | 10/13/2016
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Last Update Date | 06/05/2024
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Provider Practice Location Address
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Address Line | 106 N ANTLER ST
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City | GLADWIN
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State | MI
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Zip | 48624-1562
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Country | US
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Telephone | 989-709-5430
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Fax | 989-403-7161
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Provider Business Mailing Address
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Address Line | 106 N ANTLER ST
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City | GLADWIN
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State | MI
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Zip | 48624-1562
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Country | US
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Telephone | 989-709-5430
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Fax | 989-403-7161
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Authorized Official
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Title or Position | OWNER
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Name | DR. DEBRA HAMILTON
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Credential | PSYD, LLP
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Telephone | 989-709-5430
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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