Provider Demographics
NPI:1861542334
Name:CROSSMONT & ASSOCIATES, INC.
Entity type:Organization
Organization Name:CROSSMONT & ASSOCIATES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:EDNA
Authorized Official - Middle Name:R
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:708-229-0700
Mailing Address - Street 1:10522 S CICERO AVE
Mailing Address - Street 2:SUITE 302
Mailing Address - City:OAK LAWN
Mailing Address - State:IL
Mailing Address - Zip Code:60453-5200
Mailing Address - Country:US
Mailing Address - Phone:708-229-0700
Mailing Address - Fax:708-229-0173
Practice Address - Street 1:10522 S CICERO AVE
Practice Address - Street 2:SUITE 302
Practice Address - City:OAK LAWN
Practice Address - State:IL
Practice Address - Zip Code:60453-5200
Practice Address - Country:US
Practice Address - Phone:708-229-0700
Practice Address - Fax:708-229-0173
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-10
Last Update Date:2016-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILA-1545-0001-A101YM0800X, 101YP2500X, 101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
ILF100182823Medicare Oscar/Certification