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NPI Code Detail

MEDICARE: LESLIE CROSS LCSW

MEDICARE: LESLIE CROSS LCSW
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
1101Y00000XCounselor
21041C0700XClinical Social Worker

General Provider Information

NPI Number : 1891225041
Entity Type Code : Individual
Provider Name (Legal Business Name) : LESLIE CROSS LCSW
Provider Business Mailing Address
First Line : 960 CARRIAGE LN
Second Line :
City : CASPER
State : WY
Zip : 82609-2450
Country : US
Telephone Number : 307-751-0777
Fax Number :
Provider Business Practice Location Address
First Line : 233 E MAIN ST STE 401
Second Line :
City : BOZEMAN
State : MT
Zip : 59715-5045
Country : US
Telephone Number : 307-751-0777
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 06/19/2017
Last Update Date : 08/26/2022

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