Healthcare Provider Details

I. General information

NPI: 1023741949
Provider Name (Legal Business Name): CROSSROADS COUNSELING AND WELLNESS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2022
Last Update Date: 12/07/2022
Certification Date: 12/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

279 N WILLIS ST STE C
ABILENE TX
79603-6993
US

IV. Provider business mailing address

279 N WILLIS ST STE C
ABILENE TX
79603-6993
US

V. Phone/Fax

Practice location:
  • Phone: 325-261-0137
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TESSA WOLFORD
Title or Position: PRESIDENT AND OWNER
Credential: M.A., LPC-ASSOCIATE
Phone: 325-238-5917