Provider Demographics
NPI:1689379612
Name:CROSS, HARRY THOMAS (CIT)
Entity Type:Individual
Prefix:MR
First Name:HARRY
Middle Name:THOMAS
Last Name:CROSS
Suffix:
Gender:M
Credentials:CIT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:712 HUDSON LN APT A
Mailing Address - Street 2:
Mailing Address - City:MONROE
Mailing Address - State:LA
Mailing Address - Zip Code:71201-5565
Mailing Address - Country:US
Mailing Address - Phone:318-450-0038
Mailing Address - Fax:
Practice Address - Street 1:4600 REDDIX LN
Practice Address - Street 2:
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71202-5949
Practice Address - Country:US
Practice Address - Phone:318-582-4480
Practice Address - Fax:318-855-5084
Is Sole Proprietor?:Yes
Enumeration Date:2023-03-31
Last Update Date:2023-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LACIT-5618101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor