Provider Demographics
NPI:1154769784
Name:CROSS, ROBERT STEPHEN (LCSW)
Entity type:Individual
Prefix:
First Name:ROBERT
Middle Name:STEPHEN
Last Name:CROSS
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6612 CROW CIR
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73132-2001
Mailing Address - Country:US
Mailing Address - Phone:405-203-7582
Mailing Address - Fax:
Practice Address - Street 1:6612 CROW CIR
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73132-2001
Practice Address - Country:US
Practice Address - Phone:405-203-7582
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-06-05
Last Update Date:2013-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK00201041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical