Provider Demographics
NPI:1477936185
Name:CROSS, GINA DIANE (BCBA)
Entity Type:Individual
Prefix:MS
First Name:GINA
Middle Name:DIANE
Last Name:CROSS
Suffix:
Gender:F
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6516 BROADWAY ST STE 112
Mailing Address - Street 2:
Mailing Address - City:PEARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:77581-7879
Mailing Address - Country:US
Mailing Address - Phone:303-989-8169
Mailing Address - Fax:
Practice Address - Street 1:6516 BROADWAY ST STE 112
Practice Address - Street 2:
Practice Address - City:PEARLAND
Practice Address - State:TX
Practice Address - Zip Code:77581-7879
Practice Address - Country:US
Practice Address - Phone:720-219-6453
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-30
Last Update Date:2020-02-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1-15-18699103K00000X, 103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst