MEDICARE: SHELLY CROSS LMFT

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
1	390200000X	Student in an Organized Health Care Education/Training Program
2	106H00000X	Marriage & Family Therapist	246	NH

General Provider Information

NPI Number	:	1215486345
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHELLY CROSS LMFT

Provider Business Mailing Address
First Line	:	3 RIVER ST
Second Line	:
City	:	PETERBOROUGH
State	:	NH
Zip	:	03458-1405
Country	:	US
Telephone Number	:	603-340-4570
Fax Number	:

Provider Business Practice Location Address
First Line	:	174 CONCORD ST STE 280
Second Line	:
City	:	PETERBOROUGH
State	:	NH
Zip	:	03458-1222
Country	:	US
Telephone Number	:	603-924-3644
Fax Number	:	603-924-7420

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	09/30/2016
Last Update Date	:	11/03/2020

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Directions to “ SHELLY CROSS LMFT” Practice Location

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