MEDICARE: CROSSESSENCE MENTAL HEALTHCARE GROUP, LLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center
4	363LP0808X	Psychiatric/Mental Health Nurse Practitioner

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1972105005
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSSESSENCE MENTAL HEALTHCARE GROUP, LLC

Provider Business Mailing Address
First Line	:	2006 THOMPSON RD STE 104
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-4947
Country	:	US
Telephone Number	:	281-239-3155
Fax Number	:	800-824-9930

Provider Business Practice Location Address
First Line	:	2006 THOMPSON RD STE 104
Second Line	:
City	:	RICHMOND
State	:	TX
Zip	:	77469-4947
Country	:	US
Telephone Number	:	281-239-3155
Fax Number	:	800-824-9930

Authorized Official
Title or Position	:	PMHNP-BC
Name	:	FUNMILAYO AKINRIMISI
Credential	:	ANP
Telephone Number	:	281-536-3843

Provider Enumeration Date	:	11/13/2020
Last Update Date	:	01/25/2024

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