Provider Demographics
NPI:1578679064
Name:CROSS TIMBERS FAMILY THERAPY, PLLC
Entity Type:Organization
Organization Name:CROSS TIMBERS FAMILY THERAPY, PLLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRES & CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:D
Authorized Official - Last Name:BRADLEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:469-635-7540
Mailing Address - Street 1:2904 CORPORATE CIR
Mailing Address - Street 2:SUITE 129
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75028-2292
Mailing Address - Country:US
Mailing Address - Phone:469-435-7540
Mailing Address - Fax:
Practice Address - Street 1:2904 CORPORATE CIR
Practice Address - Street 2:SUITE 129
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028-2292
Practice Address - Country:US
Practice Address - Phone:469-435-7540
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-21
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Not Answered101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Multi-Specialty