Provider Demographics
NPI:1205292547
Name:CROSS, ALLISON
Entity type:Individual
Prefix:
First Name:ALLISON
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 1:1123 GRAND AVE APT 103
Mailing Address - Street 2:
Mailing Address - City:SAINT PAUL
Mailing Address - State:MN
Mailing Address - Zip Code:55105-2744
Mailing Address - Country:US
Mailing Address - Phone:612-305-8471
Mailing Address - Fax:
Practice Address - Street 1:1619 DAYTON AVE STE 111
Practice Address - Street 2:
Practice Address - City:SAINT PAUL
Practice Address - State:MN
Practice Address - Zip Code:55104-6276
Practice Address - Country:US
Practice Address - Phone:612-305-8471
Practice Address - Fax:612-234-4628
Is Sole Proprietor?:No
Enumeration Date:2015-12-31
Last Update Date:2019-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN3439106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist