| NPI | 1093307654 |
|---|---|
| Former Legal Business Name | CROSSROADS LAKE COUNTY ADOLESCENT COUNSELING |
| Entity Type | Organization |
| Authorized Contact | ALICE IDEN COO 440-255-1700 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center, Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 207Q00000X Family Medicine |
| 2084P0800X Psychiatry & Neurology, Psychiatry | |
| Enumeration Date | 2021-02-05 |
| Last Update Date | 2024-01-29 |