Provider Demographics
NPI:1922688191
Name:CROSS, AMANDA (MS, BCBA, LBA)
Entity Type:Individual
Prefix:
First Name:AMANDA
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:MS, BCBA, LBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:870 PHEASANT RUN AVE
Mailing Address - Street 2:
Mailing Address - City:DICKINSON
Mailing Address - State:ND
Mailing Address - Zip Code:58601-6536
Mailing Address - Country:US
Mailing Address - Phone:701-765-3064
Mailing Address - Fax:701-483-3889
Practice Address - Street 1:870 PHEASANT RUN AVE
Practice Address - Street 2:
Practice Address - City:DICKINSON
Practice Address - State:ND
Practice Address - Zip Code:58601-6536
Practice Address - Country:US
Practice Address - Phone:701-765-3064
Practice Address - Fax:701-483-3889
Is Sole Proprietor?:No
Enumeration Date:2021-04-12
Last Update Date:2021-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NDL70103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst