Provider Demographics
NPI:1841634748
Name:CROSS, JEREMYRA
Entity type:Individual
Prefix:
First Name:JEREMYRA
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5602 PRESIDIO PKWY APT 5220
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78249-3282
Mailing Address - Country:US
Mailing Address - Phone:580-514-8035
Mailing Address - Fax:
Practice Address - Street 1:5602 PRESIDIO PKWY APT 5220
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78249-3282
Practice Address - Country:US
Practice Address - Phone:210-704-7403
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2013-04-22
Last Update Date:2021-06-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
171W00000X
TX203564106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No171W00000XOther Service ProvidersContractor