Provider Demographics
NPI:1659542538
Name:CROSS-GENERATION
Entity Type:Organization
Organization Name:CROSS-GENERATION
Other - Org Name:CONNECTED FAMILIES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ASSOCIATE PARTNER
Authorized Official - Prefix:MR
Authorized Official - First Name:CHAD
Authorized Official - Middle Name:
Authorized Official - Last Name:HAYENGA
Authorized Official - Suffix:
Authorized Official - Credentials:MA, LMFT
Authorized Official - Phone:952-448-3625
Mailing Address - Street 1:566 BAVARIA LN
Mailing Address - Street 2:BOX 71
Mailing Address - City:CHASKA
Mailing Address - State:MN
Mailing Address - Zip Code:55318-4597
Mailing Address - Country:US
Mailing Address - Phone:952-448-3625
Mailing Address - Fax:952-448-3625
Practice Address - Street 1:566 BAVARIA LN
Practice Address - Street 2:BOX 71
Practice Address - City:CHASKA
Practice Address - State:MN
Practice Address - Zip Code:55318-4597
Practice Address - Country:US
Practice Address - Phone:952-448-3625
Practice Address - Fax:952-448-3625
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROSS-GENERATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-03-18
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health