Provider Demographics
NPI:1891297958
Name:CROSS, JULIA MADISON (MA, BCBA)
Entity Type:Individual
Prefix:
First Name:JULIA
Middle Name:MADISON
Last Name:CROSS
Suffix:
Gender:F
Credentials:MA, BCBA
Other - Prefix:
Other - First Name:JULIA
Other - Middle Name:MADISON
Other - Last Name:HART
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:RBT
Mailing Address - Street 1:7108 S KANNER HWY
Mailing Address - Street 2:
Mailing Address - City:STUART
Mailing Address - State:FL
Mailing Address - Zip Code:34997-7462
Mailing Address - Country:US
Mailing Address - Phone:855-832-6727
Mailing Address - Fax:772-675-9100
Practice Address - Street 1:3100 W RAY RD STE 201
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-2472
Practice Address - Country:US
Practice Address - Phone:855-832-6727
Practice Address - Fax:772-675-9100
Is Sole Proprietor?:No
Enumeration Date:2018-03-05
Last Update Date:2022-07-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
103K00000X
AZRBT-18-51288106S00000X
AZBEH-000782103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZRBT-18-51288OtherREGISTERED BEHAVIOR TECHNICIAN
1-21-50536OtherBCBA CERTIFICATE