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NPI Code Detail

MEDICARE: LEILA KAY CROSS BA

MEDICARE: LEILA KAY CROSS BA
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor
2224Z00000XOccupational Therapy Assistant2125TN

General Provider Information

NPI Number : 1003954918
Entity Type Code : Individual
Provider Name (Legal Business Name) : LEILA KAY CROSS BA
Provider Business Mailing Address
First Line : 626 E FOREST PARK DR
Second Line :
City : DICKSON
State : TN
Zip : 37055-2259
Country : US
Telephone Number : 724-496-3365
Fax Number :
Provider Business Practice Location Address
First Line : 800 VOLUNTEER DR
Second Line :
City : PARIS
State : TN
Zip : 38242-5472
Country : US
Telephone Number : 615-446-7650
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/02/2007
Last Update Date : 01/12/2015

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