Crossroads Therapy, LLC

Primary specialty

Clinical Social WorkerTaxonomy code 1041C0700X

License

14099 Issued in FL

Legal business name

CROSSROADS THERAPY, LLC

Practice address

408 4TH St N
Jacksonville Beach, FL 32250-5620

Phone

(904) 853-7780

NPI assigned

Oct 9, 2017

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Kelly Suzanne Gordon, LCSW

Title

Therapist

Phone

(904) 853-7780

Specialties & licenses 1

Addresses

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1507507200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1507507200000",
    "number": "1285144949",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "333 9TH ST",
            "city": "ATLANTIC BEACH",
            "state": "FL",
            "postal_code": "322335437"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "408 4TH ST N",
            "city": "JACKSONVILLE BEACH",
            "state": "FL",
            "postal_code": "322505620",
            "telephone_number": "904-853-7780"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CROSSROADS THERAPY, LLC",
        "organizational_subpart": "NO",
        "enumeration_date": "2017-10-09",
        "last_updated": "2017-10-09",
        "status": "A",
        "authorized_official_last_name": "GORDON",
        "authorized_official_first_name": "KELLY",
        "authorized_official_middle_name": "SUZANNE",
        "authorized_official_title_or_position": "THERAPIST",
        "authorized_official_telephone_number": "904-853-7780",
        "authorized_official_credential": "LCSW"
    },
    "taxonomies": [
        {
            "code": "1041C0700X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Social Worker, Clinical",
            "state": "FL",
            "license": "14099",
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Michelle Connolly Cribbs, M.S., CCC-SLP
• Tara Cripe, M.S., CCC-SLP
• Nicholas Cristello, ARNP
• Jerry Croan, MSW
• John Richard Crossfield, LHMC
• Tawnie Crowe, PT, DPT
• Jennifer Cruz Hernandez
• Wilfreda Jenine Cruz, LCSW, LCSW-C
• Cullum Chiropractic Centers Inc
• Kristen E Currie, M.D.

• Clinical Social Worker in Jacksonville Beach, FL
• Providers in Jacksonville Beach, FL by specialty
• Clinical Social Worker in Florida

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 9, 2017; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.