Healthcare Provider Details

I. General information

NPI: 1114425592
Provider Name (Legal Business Name): CROSS THERAPY CENTER PLLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/31/2018
Last Update Date: 01/31/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

20 FRANK ST
COUNCIL BLUFFS IA
51503-4460
US

IV. Provider business mailing address

20 FRANK ST
COUNCIL BLUFFS IA
51503-4460
US

V. Phone/Fax

Practice location:
  • Phone: 712-256-9000
  • Fax: 712-256-7710
Mailing address:
  • Phone: 712-256-9000
  • Fax: 712-256-7710

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: KATE CROSS
Title or Position: OWNER
Credential: LIMHC
Phone: 402-650-0900