Provider Demographics
NPI:1336638386
Name:CROSBY, AMBERA D (MS,LPC)
Entity Type:Individual
Prefix:
First Name:AMBERA
Middle Name:D
Last Name:CROSBY
Suffix:
Gender:F
Credentials:MS,LPC
Other - Prefix:
Other - First Name:AMBER
Other - Middle Name:D
Other - Last Name:CROSBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:4347 BENNINGTON CREEK LN
Mailing Address - Street 2:
Mailing Address - City:GROVEPORT
Mailing Address - State:OH
Mailing Address - Zip Code:43125-8900
Mailing Address - Country:US
Mailing Address - Phone:614-805-2129
Mailing Address - Fax:
Practice Address - Street 1:6321 E LIVINGSTON AVE
Practice Address - Street 2:
Practice Address - City:REYNOLDSBURG
Practice Address - State:OH
Practice Address - Zip Code:43068-4241
Practice Address - Country:US
Practice Address - Phone:714-870-6670
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-04
Last Update Date:2018-05-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OH101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health