Provider Demographics
NPI:1235434325
Name:CROSS, NICOLE MCCANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:NICOLE
Middle Name:MCCANN
Last Name:CROSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:NICOLE
Other - Middle Name:BAILEY
Other - Last Name:MCCANN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC, LMFT
Mailing Address - Street 1:18884 HARBOR SIDE BLVD
Mailing Address - Street 2:
Mailing Address - City:MONTGOMERY
Mailing Address - State:TX
Mailing Address - Zip Code:77356-3222
Mailing Address - Country:US
Mailing Address - Phone:713-385-9088
Mailing Address - Fax:
Practice Address - Street 1:16955 WALDEN RD
Practice Address - Street 2:SUITE 111
Practice Address - City:MONTGOMERY
Practice Address - State:TX
Practice Address - Zip Code:77356-3220
Practice Address - Country:US
Practice Address - Phone:713-385-9088
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-01-20
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX18990101YP2500X
TX5146106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist