Provider Demographics
NPI:1578938742
Name:CROSSROADS BEHAVIORAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:CROSSROADS BEHAVIORAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MR
Authorized Official - First Name:DARAL
Authorized Official - Middle Name:J
Authorized Official - Last Name:WRIGHT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:904-302-9929
Mailing Address - Street 1:3107 SPRING GLEN RD
Mailing Address - Street 2:SUITE 202
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32207-5916
Mailing Address - Country:US
Mailing Address - Phone:904-302-9929
Mailing Address - Fax:
Practice Address - Street 1:3107 SPRING GLEN RD
Practice Address - Street 2:SUITE 202
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32207-5916
Practice Address - Country:US
Practice Address - Phone:904-302-9929
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-12-14
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1601251B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management