MEDICARE: ROY CROSS

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	101YA0400X	Addiction (Substance Use Disorder) Counselor	42100	TX

General Provider Information

NPI Number	:	1336802958
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ROY CROSS

Provider Business Mailing Address
First Line	:	9035 NINA RD
Second Line	:
City	:	CONROE
State	:	TX
Zip	:	77304-3727
Country	:	US
Telephone Number	:	832-628-1380
Fax Number	:

Provider Business Practice Location Address
First Line	:	505 N SAM HOUSTON PKWY E STE 308
Second Line	:
City	:	HOUSTON
State	:	TX
Zip	:	77060-4086
Country	:	US
Telephone Number	:	281-999-4859
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	10/20/2021
Last Update Date	:	10/20/2021

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Directions to “ ROY CROSS ” Practice Location

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