Organization
METHADONE CLINIC OF EAST TEXAS LLC
Active
Other names
Crossroads Treatment Centers Tyler
Organization subpart
No
Provider details
NPI number
Authorized official
RUPERT MCCORMAC MD (CHIEF EXECUTIVE OFFICER)
(800) 805-6898
Entity
Organization
Contact information
Practice address
1510 S VINE AVE, TYLER, TX 75701-2826
(800) 805-6989
Mailing address
PO BOX 749057, ATLANTA, GA 30374-9057
(800) 805-6989
(864) 558-8511
Taxonomy
Speciality
Code
Description
License number
State
251S00000X
Community/Behavioral Health Agency
—
—
261QM0801X
Mental Health Clinic/Center (Including Community Mental Health Center)
—
—
261QM1300X
Multi-Specialty Clinic/Center
—
—
261QM2800X
Methadone Clinic
Primary
000039
TX
261QP2300X
Primary Care Clinic/Center
—
—
261QR0405X
Substance Use Disorder Rehabilitation Clinic/Center
—
TX
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
2121550
—
TX
Enumeration date
05/17/2010
Last updated
09/03/2024
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