Organization
CROSSROADS BEHAVIORAL HEALTH, INC.
Active
Organization subpart
No
Provider details
NPI number
Authorized official
ROBERT E JACKSON PHD (PRESIDENT)
(808) 294-3493
Entity
Organization
Contact information
Practice address
91-1010 SHANGRILA ST STE 105, KAPOLEI, HI 96707-2176
(808) 377-4300
Mailing address
PO BOX 701089, KAPOLEI, HI 96709-1089
(808) 294-3493
Taxonomy
Speciality
Code
Description
License number
State
103TC0700X
Clinical Psychologist
Primary
PSY809
HI
2084P0800X
Psychiatry Physician
—
—
2084P0804X
Child & Adolescent Psychiatry Physician
—
—
Other
Enumeration date
04/10/2018
Last updated
03/13/2019
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