Healthcare Provider Details

I. General information

NPI: 1376156471
Provider Name (Legal Business Name): CROSS COUNSELING AND COACHING, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2020
Last Update Date: 08/28/2020
Certification Date: 08/27/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7 BRONZE POINTE S STE B2
SWANSEA IL
62226-8308
US

IV. Provider business mailing address

7 BRONZE POINTE S STE B2
SWANSEA IL
62226-8308
US

V. Phone/Fax

Practice location:
  • Phone: 618-207-2547
  • Fax:
Mailing address:
  • Phone: 618-207-2547
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code163WP0807X
TaxonomyChild & Adolescent Psychiatric/Mental Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: JOCELYN R. CROSS
Title or Position: CLINIC DIRECTOR
Credential: LCSW
Phone: 618-207-2547