Provider Demographics
NPI:1750186573
Name:CROSS BRADLEY, COLETTE ROYLYN (SCHOOL COUNSELOR PPS)
Entity type:Individual
Prefix:
First Name:COLETTE
Middle Name:ROYLYN
Last Name:CROSS BRADLEY
Suffix:
Gender:
Credentials:SCHOOL COUNSELOR PPS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 S GOLD ST
Mailing Address - Street 2:
Mailing Address - City:YREKA
Mailing Address - State:CA
Mailing Address - Zip Code:96097-3110
Mailing Address - Country:US
Mailing Address - Phone:530-331-9706
Mailing Address - Fax:530-842-8436
Practice Address - Street 1:609 S GOLD ST
Practice Address - Street 2:
Practice Address - City:YREKA
Practice Address - State:CA
Practice Address - Zip Code:96097-3110
Practice Address - Country:US
Practice Address - Phone:530-331-9706
Practice Address - Fax:530-842-8436
Is Sole Proprietor?:Yes
Enumeration Date:2025-02-17
Last Update Date:2025-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA24007750101YS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool