Provider Demographics
NPI:1659774933
Name:CROSS-GENERATION
Entity Type:Organization
Organization Name:CROSS-GENERATION
Other - Org Name:SAFEGENERATIONS
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPIST
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:
Authorized Official - Last Name:ROBIDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:LMFT
Authorized Official - Phone:952-448-3625
Mailing Address - Street 1:566 BAVARIA LN
Mailing Address - Street 2:
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:
Practice Address - Street 1:566 BAVARIA LN
Practice Address - Street 2:
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:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CROSS-GENERATION
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-10-01
Last Update Date:2014-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty