Healthcare Provider Details

I. General information

NPI: 1720603343
Provider Name (Legal Business Name): CROSSING ARROWS COUNSELING SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2020
Last Update Date: 06/09/2020
Certification Date: 06/09/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

921 S CRAYCROFT RD
TUCSON AZ
85711-7112
US

IV. Provider business mailing address

12685 E LOS REALES RD
TUCSON AZ
85747-9463
US

V. Phone/Fax

Practice location:
  • Phone: 520-304-6681
  • Fax:
Mailing address:
  • Phone: 520-304-6681
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State

VIII. Authorized Official

Name: COREY DU JUAN STARKS
Title or Position: CEO
Credential:
Phone: 520-304-6681