Provider Demographics
NPI:1093476558
Name:CROSS, EMILY (MA, LADC)
Entity Type:Individual
Prefix:
First Name:EMILY
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:MA, LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:115 FORESTVIEW LN N
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:MN
Mailing Address - Zip Code:55441-5910
Mailing Address - Country:US
Mailing Address - Phone:763-546-8008
Mailing Address - Fax:
Practice Address - Street 1:115 FORESTVIEW LN N
Practice Address - Street 2:
Practice Address - City:PLYMOUTH
Practice Address - State:MN
Practice Address - Zip Code:55441-5910
Practice Address - Country:US
Practice Address - Phone:763-546-8008
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-01-06
Last Update Date:2023-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)