Provider Demographics
NPI:1952584492
Name:CROSSROADS THERAPEUTIC SERVICES
Entity type:Organization
Organization Name:CROSSROADS THERAPEUTIC SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MENTAL HEALTH THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LAURETTA
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAND
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:406-855-0781
Mailing Address - Street 1:1253 BLUEBELL DR
Mailing Address - Street 2:
Mailing Address - City:BILLINGS
Mailing Address - State:MT
Mailing Address - Zip Code:59105-4892
Mailing Address - Country:US
Mailing Address - Phone:406-855-0781
Mailing Address - Fax:
Practice Address - Street 1:926 MAIN ST
Practice Address - Street 2:SUITE #18
Practice Address - City:BILLINGS
Practice Address - State:MT
Practice Address - Zip Code:59105-3359
Practice Address - Country:US
Practice Address - Phone:406-855-0781
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-06
Last Update Date:2007-12-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1003LCPC261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)