Provider Demographics
NPI:1659779148
Name:CROSS, RENA ANN (LPC)
Entity Type:Individual
Prefix:MRS
First Name:RENA
Middle Name:ANN
Last Name:CROSS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:RENA
Other - Middle Name:A
Other - Last Name:STOEGBAUER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC-T
Mailing Address - Street 1:2905 RED WOLF TRL
Mailing Address - Street 2:
Mailing Address - City:BLUE MOUNDS
Mailing Address - State:WI
Mailing Address - Zip Code:53517-9717
Mailing Address - Country:US
Mailing Address - Phone:608-289-6436
Mailing Address - Fax:
Practice Address - Street 1:2905 RED WOLF TRL
Practice Address - Street 2:
Practice Address - City:BLUE MOUNDS
Practice Address - State:WI
Practice Address - Zip Code:53517-9717
Practice Address - Country:US
Practice Address - Phone:608-289-6436
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-12-15
Last Update Date:2024-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI6056-125101YM0800X
WI6056-LPC101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health