Provider Demographics
NPI:1083370555
Name:CROSS, CHASITY R
Entity Type:Individual
Prefix:
First Name:CHASITY
Middle Name:R
Last Name:CROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1803 7TH AVE
Mailing Address - Street 2:
Mailing Address - City:DANNEBROG
Mailing Address - State:NE
Mailing Address - Zip Code:68831-3509
Mailing Address - Country:US
Mailing Address - Phone:308-258-0580
Mailing Address - Fax:
Practice Address - Street 1:1803 7TH AVE
Practice Address - Street 2:
Practice Address - City:DANNEBROG
Practice Address - State:NE
Practice Address - Zip Code:68831-3509
Practice Address - Country:US
Practice Address - Phone:308-258-0580
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-11-09
Last Update Date:2021-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE191435106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician