Provider Demographics
NPI:1578034674
Name:CROSSMAN, ANDREW (BCBA)
Entity Type:Individual
Prefix:
First Name:ANDREW
Middle Name:
Last Name:CROSSMAN
Suffix:
Gender:M
Credentials:BCBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1570 MIDWAY DR
Mailing Address - Street 2:
Mailing Address - City:AMMON
Mailing Address - State:ID
Mailing Address - Zip Code:83406-6912
Mailing Address - Country:US
Mailing Address - Phone:208-709-0537
Mailing Address - Fax:
Practice Address - Street 1:1560 MIDWAY DR
Practice Address - Street 2:
Practice Address - City:AMMON
Practice Address - State:ID
Practice Address - Zip Code:83406-6912
Practice Address - Country:US
Practice Address - Phone:208-522-1217
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-12-16
Last Update Date:2018-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID1-18-32244103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst