Provider Demographics
NPI:1760716179
Name:CROSS, KARA (PHD)
Entity Type:Individual
Prefix:DR
First Name:KARA
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:26052 RAMJIT CT
Mailing Address - Street 2:
Mailing Address - City:LAKE FOREST
Mailing Address - State:CA
Mailing Address - Zip Code:92630-5535
Mailing Address - Country:US
Mailing Address - Phone:949-458-6781
Mailing Address - Fax:949-458-6781
Practice Address - Street 1:26052 RAMJIT CT
Practice Address - Street 2:
Practice Address - City:LAKE FOREST
Practice Address - State:CA
Practice Address - Zip Code:92630-5535
Practice Address - Country:US
Practice Address - Phone:949-458-6781
Practice Address - Fax:949-458-6781
Is Sole Proprietor?:No
Enumeration Date:2009-10-01
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVPY0574103TC0700X
CAPSY8514103TC0700X
CO3186103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical