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NPI Code Detail

MEDICARE: CROSSROADS BEHAVIOR CONSULTATION LLC

MEDICARE: CROSSROADS BEHAVIOR CONSULTATION LLC
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
1103K00000XBehavior Analyst

General Provider Information

NPI Number : 1730497215
Entity Type Code : Organization
Provider Name (Legal Business Name) : CROSSROADS BEHAVIOR CONSULTATION LLC
Provider Business Mailing Address
First Line : PO BOX 1193
Second Line :
City : ELKO
State : NV
Zip : 89803-1193
Country : US
Telephone Number : 775-934-5810
Fax Number :
Provider Business Practice Location Address
First Line : 512 COMMERCIAL ST
Second Line :
City : ELKO
State : NV
Zip : 89801-3741
Country : US
Telephone Number : 775-934-5810
Fax Number :
Authorized Official
Title or Position : BCBA
Name : MRS. MICHELLE RENEE CANNING
Credential :
Telephone Number : 775-934-5810
Provider Enumeration Date : 09/19/2010
Last Update Date : 09/19/2010

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