Provider Demographics
NPI:1831411149
Name:CROSSROADS WELLNESS, LLC
Entity type:Organization
Organization Name:CROSSROADS WELLNESS, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING MEMBER
Authorized Official - Prefix:DR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:CROSS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:702-480-4891
Mailing Address - Street 1:7465 W LAKE MEAD BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1032
Mailing Address - Country:US
Mailing Address - Phone:702-480-4891
Mailing Address - Fax:702-562-1221
Practice Address - Street 1:7465 W LAKE MEAD BLVD
Practice Address - Street 2:STE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1032
Practice Address - Country:US
Practice Address - Phone:702-480-4891
Practice Address - Fax:702-562-1221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-03-01
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV125-LC101YA0400X
NV1117106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty