Provider Demographics
NPI:1568550234
Name:CROSS, KAREN ANN (PHD)
Entity Type:Individual
Prefix:DR
First Name:KAREN
Middle Name:ANN
Last Name:CROSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5480 BALTIMORE DR
Mailing Address - Street 2:SUITE 103
Mailing Address - City:LA MESA
Mailing Address - State:CA
Mailing Address - Zip Code:91942-2020
Mailing Address - Country:US
Mailing Address - Phone:858-229-1282
Mailing Address - Fax:
Practice Address - Street 1:5480 BALTIMORE DR
Practice Address - Street 2:SUITE 103
Practice Address - City:LA MESA
Practice Address - State:CA
Practice Address - Zip Code:91942-2020
Practice Address - Country:US
Practice Address - Phone:858-229-1282
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-10
Last Update Date:2010-12-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA15113103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
CAPSY151130Medicaid
CACP15113Medicare ID - Type UnspecifiedMEDICARE NUMBER