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General NPI Number Information
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NPI Number | 1386290724
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Entity Type | Organization
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Legal Business Name | ALLEGIANCE RESILIENCY THERAPY L.L.C.
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Dates
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Enumeration Date | 08/12/2019
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Last Update Date | 10/05/2022
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Provider Practice Location Address
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Address Line | 550 N MAIN ST STE A
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City | CRESTVIEW
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State | FL
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Zip | 32536-3506
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Country | US
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Telephone | 850-238-7131
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Fax |
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Provider Business Mailing Address
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Address Line | 550 N MAIN ST STE A
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City | CRESTVIEW
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State | FL
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Zip | 32536-3506
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Country | US
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Telephone | 850-238-7131
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | MS. PATRICIA CROSS
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Credential | MS, LMHC
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Telephone | 850-238-7131
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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