Provider Demographics
NPI:1992385033
Name:CROSSROADS
Entity Type:Organization
Organization Name:CROSSROADS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COUNSELOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TAMMY
Authorized Official - Middle Name:S
Authorized Official - Last Name:ARNOLD-BULLS
Authorized Official - Suffix:
Authorized Official - Credentials:LCDC
Authorized Official - Phone:817-386-9180
Mailing Address - Street 1:6733 CAMP BOWIE BLVD
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76116-7112
Mailing Address - Country:US
Mailing Address - Phone:817-386-9180
Mailing Address - Fax:817-386-9138
Practice Address - Street 1:6733 CAMP BOWIE BLVD
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76116-7112
Practice Address - Country:US
Practice Address - Phone:817-386-9180
Practice Address - Fax:817-386-9138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-04-13
Last Update Date:2021-04-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes276400000XHospital UnitsRehabilitation, Substance Use Disorder Unit