Healthcare Provider Details

I. General information

NPI: 1053472779
Provider Name (Legal Business Name): CINDY ANN PRIVITT CROSS BSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 12/13/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

162 E CARSON ST
COLUSA CA
95932-2880
US

IV. Provider business mailing address

162 E. CARSON ST.
COLUSA CA
95932
US

V. Phone/Fax

Practice location:
  • Phone: 530-458-0520
  • Fax: 530-458-7751
Mailing address:
  • Phone: 530-458-0520
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code225C00000X
TaxonomyRehabilitation Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: