Provider Demographics
NPI:1629486576
Name:CROSS, TRACY
Entity Type:Individual
Prefix:
First Name:TRACY
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10827 HABANERO WAY SE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87123-4250
Mailing Address - Country:US
Mailing Address - Phone:505-321-9817
Mailing Address - Fax:
Practice Address - Street 1:6121 INDIAN SCHOOL RD NE
Practice Address - Street 2:SUITE 234
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87110-4140
Practice Address - Country:US
Practice Address - Phone:505-888-1362
Practice Address - Fax:505-888-1376
Is Sole Proprietor?:No
Enumeration Date:2014-07-23
Last Update Date:2019-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMC-106001041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical