Provider Demographics
NPI:1922014166
Name:CROSS, JANNETTE (PHD)
Entity Type:Individual
Prefix:DR
First Name:JANNETTE
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 1:4747 RESEARCH FOREST DR SUITE 180 #559
Mailing Address - Street 2:
Mailing Address - City:THE WOODLANDS
Mailing Address - State:TX
Mailing Address - Zip Code:77381-1716
Mailing Address - Country:US
Mailing Address - Phone:832-728-9398
Mailing Address - Fax:
Practice Address - Street 1:4747 RESEARCH FOREST DR SUITE 180 #559
Practice Address - Street 2:
Practice Address - City:THE WOODLANDS
Practice Address - State:TX
Practice Address - Zip Code:77381-1716
Practice Address - Country:US
Practice Address - Phone:832-728-9398
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-31
Last Update Date:2019-10-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2003011958103TC0700X
TX37288103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO491360103Medicaid
MO000021742Medicare ID - Type UnspecifiedPROVIDER #