Provider Demographics
NPI:1578623377
Name:CROSS, JEFFREY CARL (MA)
Entity Type:Individual
Prefix:
First Name:JEFFREY
Middle Name:CARL
Last Name:CROSS
Suffix:
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:121 5TH AVE W
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:MN
Mailing Address - Zip Code:56308-1303
Mailing Address - Country:US
Mailing Address - Phone:320-759-3096
Mailing Address - Fax:320-759-3097
Practice Address - Street 1:121 5TH AVE W
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:MN
Practice Address - Zip Code:56308-1303
Practice Address - Country:US
Practice Address - Phone:320-759-3096
Practice Address - Fax:320-759-3097
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2022-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health