MEDICARE: CROSSPOINT AUTISM THERAPY

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103K00000X	Behavioral Analyst	1-13-13966	TX

General Provider Information

NPI Number	:	1215333422
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSPOINT AUTISM THERAPY

Provider Business Mailing Address
First Line	:	2831 ELDORADO PKWY
Second Line	:	103-187
City	:	FRISCO
State	:	TX
Zip	:	75033-7438
Country	:	US
Telephone Number	:	214-725-2344
Fax Number	:

Provider Business Practice Location Address
First Line	:	2831 ELDORADO PKWY
Second Line	:	103-187
City	:	FRISCO
State	:	TX
Zip	:	75033-7438
Country	:	US
Telephone Number	:	214-725-2344
Fax Number	:

Authorized Official
Title or Position	:	BOARD CERTIFIED BEHAVIOR ANALYST
Name	:	MRS. KRISTIN FIDA
Credential	:	M. ED
Telephone Number	:	325-227-3885

Provider Enumeration Date	:	11/15/2014
Last Update Date	:	04/21/2017

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