MEDICARE: CROSS COUNSELING

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	101Y00000X	Counselor

General Provider Information

NPI Number	:	1447084801
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CROSS COUNSELING

Provider Business Mailing Address
First Line	:	3071 N HENDERSON RD
Second Line	:
City	:	DAVISON
State	:	MI
Zip	:	48423-8113
Country	:	US
Telephone Number	:	810-922-6313
Fax Number	:

Provider Business Practice Location Address
First Line	:	3000 LEONARD ST NE
Second Line	:
City	:	GRAND RAPIDS
State	:	MI
Zip	:	49525-5831
Country	:	US
Telephone Number	:	810-922-6313
Fax Number	:

Authorized Official
Title or Position	:	LICENSE PROFESSIONAL COUNSELOR
Name	:	JORDAN LYNN CROSS
Credential	:	MA
Telephone Number	:	810-922-6313

Provider Enumeration Date	:	08/28/2024
Last Update Date	:	08/28/2024

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