Provider Demographics
NPI:1336630706
Name:CROSS, SUNDAY BETH (LMSW)
Entity Type:Individual
Prefix:
First Name:SUNDAY
Middle Name:BETH
Last Name:CROSS
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10020 W FAIRVIEW AVE STE 204
Mailing Address - Street 2:
Mailing Address - City:BOISE
Mailing Address - State:ID
Mailing Address - Zip Code:83704-8571
Mailing Address - Country:US
Mailing Address - Phone:208-991-4649
Mailing Address - Fax:208-906-8680
Practice Address - Street 1:10020 W FAIRVIEW AVE STE 204
Practice Address - Street 2:
Practice Address - City:BOISE
Practice Address - State:ID
Practice Address - Zip Code:83704-8571
Practice Address - Country:US
Practice Address - Phone:208-991-4649
Practice Address - Fax:208-906-8680
Is Sole Proprietor?:No
Enumeration Date:2018-05-22
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LMSW37225101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID37225OtherLMSW