Provider Demographics
NPI:1174924310
Name:AT THE CROSSROADS
Entity type:Organization
Organization Name:AT THE CROSSROADS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:VAUGHN
Authorized Official - Middle Name:
Authorized Official - Last Name:HEATH
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:801-690-6247
Mailing Address - Street 1:PO BOX 377
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:UT
Mailing Address - Zip Code:84780
Mailing Address - Country:US
Mailing Address - Phone:801-690-6247
Mailing Address - Fax:435-251-8067
Practice Address - Street 1:139 NORTH 100 WEST
Practice Address - Street 2:
Practice Address - City:ST. GEORGE
Practice Address - State:UT
Practice Address - Zip Code:84770
Practice Address - Country:US
Practice Address - Phone:801-690-6247
Practice Address - Fax:435-251-8067
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-09-08
Last Update Date:2014-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT9875261QM0850X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT9875OtherDEPARTMENT OF HUMAN SERVICES OFFICE OF LICENSING/ OUTPATIENT TREATMENT
UT8513OtherDEPARTMENT OF HUMAN SERVICES OFFICE OF LICENSING/DAY TREATMENT