Provider Demographics
NPI:1750597647
Name:CROSS, TINA MARIE (BCBA, DT)
Entity type:Individual
Prefix:
First Name:TINA
Middle Name:MARIE
Last Name:CROSS
Suffix:
Gender:
Credentials:BCBA, DT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1 WOOD CREEK RD # 1
Mailing Address - Street 2:
Mailing Address - City:BARRINGTON
Mailing Address - State:IL
Mailing Address - Zip Code:60010-9362
Mailing Address - Country:US
Mailing Address - Phone:630-886-8375
Mailing Address - Fax:
Practice Address - Street 1:1 WOOD CREEK RD
Practice Address - Street 2:
Practice Address - City:BARRINGTON
Practice Address - State:IL
Practice Address - Zip Code:60010-9362
Practice Address - Country:US
Practice Address - Phone:630-886-8375
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2025-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ILTC92450503P222Q00000X
IL1-25-80016103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No222Q00000XRespiratory, Developmental, Rehabilitative and Restorative Service ProvidersDevelopmental Therapist