Provider Demographics
NPI:1609125947
Name:VETERANS AFFAIRS
Entity Type:Organization
Organization Name:VETERANS AFFAIRS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADDICTION THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:EUGENE
Authorized Official - Last Name:CRYST
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:903-583-6411
Mailing Address - Street 1:1201 E 9TH ST
Mailing Address - Street 2:
Mailing Address - City:BONHAM
Mailing Address - State:TX
Mailing Address - Zip Code:75418-4059
Mailing Address - Country:US
Mailing Address - Phone:903-583-6411
Mailing Address - Fax:903-583-6687
Practice Address - Street 1:1201 EAST 9TH STREET
Practice Address - Street 2:
Practice Address - City:BONHAM
Practice Address - State:TX
Practice Address - Zip Code:75418
Practice Address - Country:US
Practice Address - Phone:903-583-6411
Practice Address - Fax:903-583-6687
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-08-31
Last Update Date:2012-08-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)Group - Multi-Specialty