Healthcare Provider Details

I. General information

NPI: 1447084801
Provider Name (Legal Business Name): CROSS COUNSELING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/28/2024
Last Update Date: 08/28/2024
Certification Date: 08/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3000 LEONARD ST NE
GRAND RAPIDS MI
49525-5831
US

IV. Provider business mailing address

3071 N HENDERSON RD
DAVISON MI
48423-8113
US

V. Phone/Fax

Practice location:
  • Phone: 810-922-6313
  • Fax:
Mailing address:
  • Phone: 810-922-6313
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number
License Number State

VIII. Authorized Official

Name: JORDAN LYNN CROSS
Title or Position: LICENSE PROFESSIONAL COUNSELOR
Credential: MA
Phone: 810-922-6313