Provider Demographics
NPI:1790018570
Name:CROSS, LAURIE (MED)
Entity Type:Individual
Prefix:
First Name:LAURIE
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1420 NEAL ST
Mailing Address - Street 2:SUITE 202
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-4333
Mailing Address - Country:US
Mailing Address - Phone:931-525-6900
Mailing Address - Fax:931-525-6970
Practice Address - Street 1:735 W COLUMBIA AVE
Practice Address - Street 2:
Practice Address - City:MONTICELLO
Practice Address - State:KY
Practice Address - Zip Code:42633-1627
Practice Address - Country:US
Practice Address - Phone:606-396-3488
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-11
Last Update Date:2023-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health