Provider Demographics
NPI:1417230582
Name:CROSS, KATE KATHLEEN LARAINE (MA, LMHC, LIMHP)
Entity Type:Individual
Prefix:
First Name:KATE KATHLEEN
Middle Name:LARAINE
Last Name:CROSS
Suffix:
Gender:F
Credentials:MA, LMHC, LIMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:180 WENDOVER DR
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51503-5238
Mailing Address - Country:US
Mailing Address - Phone:402-650-0900
Mailing Address - Fax:
Practice Address - Street 1:20 FRANK ST
Practice Address - Street 2:
Practice Address - City:COUNCIL BLUFFS
Practice Address - State:IA
Practice Address - Zip Code:51503-4460
Practice Address - Country:US
Practice Address - Phone:712-256-9000
Practice Address - Fax:712-256-9707
Is Sole Proprietor?:Yes
Enumeration Date:2011-09-24
Last Update Date:2014-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA001262101YM0800X
NE1221101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA0106580Medicaid