Provider Demographics
NPI:1346004504
Name:CROSS, DOUGLAS E SR (LCDC)
Entity Type:Individual
Prefix:MR
First Name:DOUGLAS
Middle Name:E
Last Name:CROSS
Suffix:SR
Gender:M
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10330 LAKE RD
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77070-1695
Mailing Address - Country:US
Mailing Address - Phone:832-883-4784
Mailing Address - Fax:
Practice Address - Street 1:10330 LAKE RD
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77070-1695
Practice Address - Country:US
Practice Address - Phone:832-883-4784
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-02-08
Last Update Date:2024-02-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13135101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)