MEDICARE: DR. CHAD LEE CROSS PHD

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	106H00000X	Marriage & Family Therapist	1117	NV
2	101YA0400X	Addiction (Substance Use Disorder) Counselor	125-LC	NV

General Provider Information

NPI Number	:	1477769438
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. CHAD LEE CROSS PHD

Provider Business Mailing Address
First Line	:	7465 W LAKE MEAD BLVD
Second Line	:	STE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1032
Country	:	US
Telephone Number	:	702-480-4891
Fax Number	:	702-562-1221

Provider Business Practice Location Address
First Line	:	7465 W LAKE MEAD BLVD
Second Line	:	STE 100
City	:	LAS VEGAS
State	:	NV
Zip	:	89128-1032
Country	:	US
Telephone Number	:	702-480-4891
Fax Number	:	702-562-1221

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

Provider Enumeration Date	:	05/15/2007
Last Update Date	:	01/20/2011

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