Provider Demographics
NPI:1790282572
Name:CROSS, MICHELLE LYNN (CADC)
Entity Type:Individual
Prefix:
First Name:MICHELLE
Middle Name:LYNN
Last Name:CROSS
Suffix:
Gender:F
Credentials:CADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1211 VINE ST
Mailing Address - Street 2:
Mailing Address - City:WEST DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50265-4472
Mailing Address - Country:US
Mailing Address - Phone:515-783-6766
Mailing Address - Fax:
Practice Address - Street 1:BRIDGES OF IOWA
Practice Address - Street 2:1985 NE 51ST PL, DES MOINES, IA 50313
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313
Practice Address - Country:US
Practice Address - Phone:515-783-6766
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-09
Last Update Date:2018-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IA15103101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)