Provider Demographics
NPI:1881429579
Name:CROSS, PHYLLIS CHERVETTE (MA)
Entity type:Individual
Prefix:
First Name:PHYLLIS
Middle Name:CHERVETTE
Last Name:CROSS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:801 JOSEPH AVE
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37207-5947
Mailing Address - Country:US
Mailing Address - Phone:615-543-5711
Mailing Address - Fax:
Practice Address - Street 1:107 DONELSON PIKE UNIT A
Practice Address - Street 2:
Practice Address - City:NASHVILLE
Practice Address - State:TN
Practice Address - Zip Code:37214-2901
Practice Address - Country:US
Practice Address - Phone:615-543-5711
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-03
Last Update Date:2024-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty