Provider Demographics
NPI:1093193658
Name:CROSS, LAURA R (LCPC)
Entity type:Individual
Prefix:
First Name:LAURA
Middle Name:R
Last Name:CROSS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:305 W MERCURY ST
Mailing Address - Street 2:STE 403
Mailing Address - City:BUTTE
Mailing Address - State:MT
Mailing Address - Zip Code:59701-1659
Mailing Address - Country:US
Mailing Address - Phone:303-525-3658
Mailing Address - Fax:
Practice Address - Street 1:305 W MERCURY ST
Practice Address - Street 2:STE 403
Practice Address - City:BUTTE
Practice Address - State:MT
Practice Address - Zip Code:59701-1659
Practice Address - Country:US
Practice Address - Phone:303-525-3658
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-05-14
Last Update Date:2016-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT12014101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional