Provider Demographics
NPI:1881211829
Name:CROSS, SARAH JO (LCSW)
Entity Type:Individual
Prefix:
First Name:SARAH
Middle Name:JO
Last Name:CROSS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:406 N SPRING ST STE 2
Mailing Address - Street 2:
Mailing Address - City:PERRYVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63775-1912
Mailing Address - Country:US
Mailing Address - Phone:573-547-8305
Mailing Address - Fax:573-547-8306
Practice Address - Street 1:406 N SPRING ST STE 2
Practice Address - Street 2:
Practice Address - City:PERRYVILLE
Practice Address - State:MO
Practice Address - Zip Code:63775-1912
Practice Address - Country:US
Practice Address - Phone:573-547-8305
Practice Address - Fax:573-547-8306
Is Sole Proprietor?:No
Enumeration Date:2020-06-25
Last Update Date:2022-08-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20220258201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO490084675Medicaid