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General NPI Number Information
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NPI Number | 1104600907
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Entity Type | Organization
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Legal Business Name | CROSSROADS GENIUS CAMPERS, INC.
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Dates
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Enumeration Date | 08/22/2023
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Last Update Date | 08/22/2023
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Provider Practice Location Address
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Address Line | 6031 VICTORY DR
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City | HOUSTON
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State | TX
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Zip | 77088-6636
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Country | US
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Telephone | 346-291-8205
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Fax |
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Provider Business Mailing Address
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Address Line | 6031 VICTORY DR
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City | HOUSTON
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State | TX
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Zip | 77088-6636
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Country | US
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Telephone | 346-291-8205
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | DAWN J BROOKS
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Credential | MA
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Telephone | 346-291-8205
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101200000X
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Taxonomy Name | Drama Therapist
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251B00000X
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Taxonomy Name | Case Management Agency
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License Number |
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License Number State |
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