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General NPI Number Information
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NPI Number | 1467409516
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Entity Type | Organization
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Legal Business Name | CROSSROADS PSYCHOTHERAPY GROUP INC.
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Dates
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Enumeration Date | 05/27/2006
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Last Update Date | 08/14/2013
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Provider Practice Location Address
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Address Line | 6615 E PACIFIC COAST HWY SUITE #115
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City | LONG BEACH
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State | CA
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Zip | 90803-4211
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Country | US
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Telephone | 562-596-0090
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Fax | 562-596-0094
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Provider Business Mailing Address
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Address Line | 16033 BOLSA CHICA ST SUITE #104-239
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City | HUNTINGTON BEACH
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State | CA
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Zip | 92649-2452
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Country | US
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Telephone | 714-846-8230
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Fax | 714-840-6508
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Authorized Official
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Title or Position | CEO/ CLINICAL PSYCHOLOGIST
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Name | DR. DEBORAH G. MATHER
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Credential | PH.D.
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Telephone | 714-846-8230
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number |
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License Number State |
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