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General NPI Number Information
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NPI Number | 1902916976
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Entity Type | Organization
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Legal Business Name | CROSSROADS COMMUNITY COUNSELING
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Dates
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Enumeration Date | 08/30/2006
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Last Update Date | 08/22/2020
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Provider Practice Location Address
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Address Line | 1701 QUINCY AVE SUITE 31
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City | NAPERVILLE
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State | IL
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Zip | 60540-3955
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Country | US
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Telephone | 630-428-1056
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Fax | 630-428-1167
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Provider Business Mailing Address
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Address Line | 1701 QUINCY AVE SUITE 31
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City | NAPERVILLE
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State | IL
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Zip | 60540-3955
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Country | US
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Telephone | 630-428-1056
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Fax | 630-428-1167
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Authorized Official
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Title or Position | PASTOR
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Name | MICHAEL M MURPHY
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Credential |
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Telephone | 630-428-1056
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 103T00000X
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Taxonomy Name | Psychologist
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License Number |
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License Number State |
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