Provider Demographics
NPI:1548915226
Name:CROSSING THE BRIDGE, COUNSELING SERVICES, L.L.C.
Entity type:Organization
Organization Name:CROSSING THE BRIDGE, COUNSELING SERVICES, L.L.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED MENTAL HEALTH COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:DAISY
Authorized Official - Middle Name:
Authorized Official - Last Name:ROMAN
Authorized Official - Suffix:
Authorized Official - Credentials:EDS, MS, QS
Authorized Official - Phone:407-230-2357
Mailing Address - Street 1:PO BOX 120802
Mailing Address - Street 2:
Mailing Address - City:CLERMONT
Mailing Address - State:FL
Mailing Address - Zip Code:34712-0802
Mailing Address - Country:US
Mailing Address - Phone:407-230-2357
Mailing Address - Fax:
Practice Address - Street 1:17301 PAGONIA RD STE 220A
Practice Address - Street 2:
Practice Address - City:CLERMONT
Practice Address - State:FL
Practice Address - Zip Code:34711-5996
Practice Address - Country:US
Practice Address - Phone:407-230-2357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-02-21
Last Update Date:2022-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL1326375601OtherNPI