Provider Demographics
NPI:1861972192
Name:CROSSROADS MENTAL HEALTH SERVICES, PLLC
Entity type:Organization
Organization Name:CROSSROADS MENTAL HEALTH SERVICES, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:AMY
Authorized Official - Middle Name:
Authorized Official - Last Name:KELLISON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:806-778-8800
Mailing Address - Street 1:812 W 8TH ST STE 6A
Mailing Address - Street 2:
Mailing Address - City:PLAINVIEW
Mailing Address - State:TX
Mailing Address - Zip Code:79072-7931
Mailing Address - Country:US
Mailing Address - Phone:806-429-2656
Mailing Address - Fax:833-477-1234
Practice Address - Street 1:812 W 8TH ST STE 6A
Practice Address - Street 2:
Practice Address - City:PLAINVIEW
Practice Address - State:TX
Practice Address - Zip Code:79072-7931
Practice Address - Country:US
Practice Address - Phone:806-429-2656
Practice Address - Fax:833-477-1234
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-08-16
Last Update Date:2023-03-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty