Provider Demographics
NPI:1477769438
Name:CROSS, CHAD LEE (PHD)
Entity Type:Individual
Prefix:DR
First Name:CHAD
Middle Name:LEE
Last Name:CROSS
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7465 W LAKE MEAD BLVD
Mailing Address - Street 2:STE 100
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89128-1032
Mailing Address - Country:US
Mailing Address - Phone:702-480-4891
Mailing Address - Fax:702-562-1221
Practice Address - Street 1:7465 W LAKE MEAD BLVD
Practice Address - Street 2:STE 100
Practice Address - City:LAS VEGAS
Practice Address - State:NV
Practice Address - Zip Code:89128-1032
Practice Address - Country:US
Practice Address - Phone:702-480-4891
Practice Address - Fax:702-562-1221
Is Sole Proprietor?:No
Enumeration Date:2007-05-15
Last Update Date:2011-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NV1117106H00000X
NV125-LC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)