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General NPI Number Information
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NPI Number | 1831411149
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Entity Type | Organization
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Legal Business Name | CROSSROADS WELLNESS, LLC
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Dates
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Enumeration Date | 03/01/2010
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Last Update Date | 01/20/2011
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Provider Practice Location Address
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Address Line | 7465 W LAKE MEAD BLVD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89128-1032
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Country | US
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Telephone | 702-480-4891
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Fax | 702-562-1221
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Provider Business Mailing Address
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Address Line | 7465 W LAKE MEAD BLVD STE 100
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City | LAS VEGAS
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State | NV
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Zip | 89128-1032
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Country | US
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Telephone | 702-480-4891
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Fax | 702-562-1221
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Authorized Official
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Title or Position | MANAGING MEMBER
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Name | DR. CHAD LEE CROSS
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Credential | PHD
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Telephone | 702-480-4891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 125-LC
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License Number State | NV
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Taxonomy #2
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Taxonomy Code | 106H00000X
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Taxonomy Name | Marriage & Family Therapist
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License Number | 1117
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License Number State | NV
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