Provider Demographics
NPI:1073257820
Name:CROSS-LOMELI, HEAVEN LEE
Entity Type:Individual
Prefix:
First Name:HEAVEN
Middle Name:LEE
Last Name:CROSS-LOMELI
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:HEAVEN
Other - Middle Name:LEE
Other - Last Name:CROSS-BOWMAN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:8020 W SAHARA AVE
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89117-7939
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:8020 W SAHARA AVE
Practice Address - Street 2:
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89117-7939
Practice Address - Country:US
Practice Address - Phone:702-470-0620
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-26
Last Update Date:2022-04-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician