Provider Demographics
NPI:1235833450
Name:CROSS, ELIZABETH A
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
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 1:300 SMITH ST
Mailing Address - Street 2:
Mailing Address - City:BELMONT
Mailing Address - State:WV
Mailing Address - Zip Code:26134-9746
Mailing Address - Country:US
Mailing Address - Phone:304-482-9039
Mailing Address - Fax:
Practice Address - Street 1:300 SMITH ST
Practice Address - Street 2:
Practice Address - City:BELMONT
Practice Address - State:WV
Practice Address - Zip Code:26134-9746
Practice Address - Country:US
Practice Address - Phone:304-482-9039
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-03-30
Last Update Date:2023-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician