Healthcare Provider Details

I. General information

NPI: 1437519766
Provider Name (Legal Business Name): STEPHANIE CROSS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 02/29/2016
Last Update Date: 09/21/2026
Certification Date: 09/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

320 11TH AVE S STE 204
NAMPA ID
83651-5074
US

IV. Provider business mailing address

10592 HOT SPRINGS AVE
NAMPA ID
83687-5770
US

V. Phone/Fax

Practice location:
  • Phone: 208-603-4656
  • Fax: 208-228-8688
Mailing address:
  • Phone: 208-989-2560
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLCPC-7017
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License NumberLCPC-7017
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: