MEDICARE: CROSSROADS THERAPEUTIC SERVICES

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	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)	1003LCPC	MT

General Provider Information

NPI Number	:	1952584492
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSROADS THERAPEUTIC SERVICES

Provider Business Mailing Address
First Line	:	1253 BLUEBELL DR
Second Line	:
City	:	BILLINGS
State	:	MT
Zip	:	59105-4892
Country	:	US
Telephone Number	:	406-855-0781
Fax Number	:

Provider Business Practice Location Address
First Line	:	926 MAIN ST
Second Line	:	SUITE #18
City	:	BILLINGS
State	:	MT
Zip	:	59105-3359
Country	:	US
Telephone Number	:	406-855-0781
Fax Number	:

Authorized Official
Title or Position	:	MENTAL HEALTH THERAPIST
Name	:	MS. LAURETTA J SAND
Credential	:
Telephone Number	:	406-855-0781

Provider Enumeration Date	:	12/06/2007
Last Update Date	:	12/06/2007

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