Provider Demographics
NPI:1942617212
Name:CROSS, JEARL JERRI (EDS,LPC/MHSP, CPSII)
Entity Type:Individual
Prefix:
First Name:JEARL JERRI
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:EDS,LPC/MHSP, CPSII
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:441 E BROAD ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:COOKEVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:38501-3389
Mailing Address - Country:US
Mailing Address - Phone:931-214-0527
Mailing Address - Fax:931-520-0767
Practice Address - Street 1:441 E BROAD ST
Practice Address - Street 2:SUITE B
Practice Address - City:COOKEVILLE
Practice Address - State:TN
Practice Address - Zip Code:38501-3389
Practice Address - Country:US
Practice Address - Phone:931-214-0527
Practice Address - Fax:931-520-0767
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-17
Last Update Date:2015-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TNLPC0000003149101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ0134971Medicaid