Provider Demographics
NPI:1861766958
Name:CROSS, SCOTT (PHD, LP, BCBA-D)
Entity type:Individual
Prefix:DR
First Name:SCOTT
Middle Name:
Last Name:CROSS
Suffix:
Gender:M
Credentials:PHD, LP, BCBA-D
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6167 BRISTOL PKWY
Mailing Address - Street 2:SUITE NUMBER 130
Mailing Address - City:CULVER CITY
Mailing Address - State:CA
Mailing Address - Zip Code:90230-6610
Mailing Address - Country:US
Mailing Address - Phone:310-410-4450
Mailing Address - Fax:310-410-4455
Practice Address - Street 1:6167 BRISTOL PKWY
Practice Address - Street 2:SUITE NUMBER 130
Practice Address - City:CULVER CITY
Practice Address - State:CA
Practice Address - Zip Code:90230-6610
Practice Address - Country:US
Practice Address - Phone:310-410-4450
Practice Address - Fax:310-410-4455
Is Sole Proprietor?:No
Enumeration Date:2012-03-07
Last Update Date:2012-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1-00-0252103K00000X
CA23924103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst