Provider Demographics
NPI:1942772637
Name:CROSS, CHERYL KAY (CDP)
Entity Type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:KAY
Last Name:CROSS
Suffix:
Gender:F
Credentials:CDP
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:KAY
Other - Last Name:MILLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CDP
Mailing Address - Street 1:3400 W GARLAND AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99205-2119
Mailing Address - Country:US
Mailing Address - Phone:509-325-2355
Mailing Address - Fax:509-327-3370
Practice Address - Street 1:4214 N CEDAR ST
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99205-1323
Practice Address - Country:US
Practice Address - Phone:509-325-2355
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-12-19
Last Update Date:2018-12-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP60145178101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA$$$$$$$$$Medicaid