Provider Demographics
NPI:1104075969
Name:CROSSON, KELLY R
Entity type:Individual
Prefix:MS
First Name:KELLY
Middle Name:R
Last Name:CROSSON
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 1:3010 STEILACOOM BLVD APT 14
Mailing Address - Street 2:
Mailing Address - City:STEILACOOM
Mailing Address - State:WA
Mailing Address - Zip Code:98388-1689
Mailing Address - Country:US
Mailing Address - Phone:253-376-5083
Mailing Address - Fax:253-396-5057
Practice Address - Street 1:514 S 13TH ST
Practice Address - Street 2:
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98402-1908
Practice Address - Country:US
Practice Address - Phone:253-396-5000
Practice Address - Fax:253-396-5057
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-16
Last Update Date:2008-09-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor