MEDICARE: CROSSROADS SYSTEMS

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

General Provider Information

NPI Number	:	1811325301
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS SYSTEMS

Provider Business Mailing Address
First Line	:	1364 S HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-1042
Country	:	US
Telephone Number	:	614-445-0352
Fax Number	:	614-445-0121

Provider Business Practice Location Address
First Line	:	1364 S HIGH ST
Second Line	:
City	:	COLUMBUS
State	:	OH
Zip	:	43207-1042
Country	:	US
Telephone Number	:	614-445-0352
Fax Number	:	614-445-0121

Authorized Official
Title or Position	:	CEO
Name	:	TIMOTHY SHAUN JESSE
Credential	:
Telephone Number	:	614-445-0352

Provider Enumeration Date	:	10/22/2013
Last Update Date	:	10/22/2013

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Directions to “CROSSROADS SYSTEMS ” Practice Location

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