Provider Demographics
NPI:1215291737
Name:CROSS BAYLESS, ELIZABETH A (LISW)
Entity type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:A
Last Name:CROSS BAYLESS
Suffix:
Gender:F
Credentials:LISW
Other - Prefix:
Other - First Name:LIZ
Other - Middle Name:A
Other - Last Name:CROSS
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LISW
Mailing Address - Street 1:6506 MENDIUS AVE NE
Mailing Address - Street 2:
Mailing Address - City:ALBUQUERQUE
Mailing Address - State:NM
Mailing Address - Zip Code:87109-4091
Mailing Address - Country:US
Mailing Address - Phone:505-310-2114
Mailing Address - Fax:
Practice Address - Street 1:6200 SEAGULL ST NE STE C
Practice Address - Street 2:
Practice Address - City:ALBUQUERQUE
Practice Address - State:NM
Practice Address - Zip Code:87109-2547
Practice Address - Country:US
Practice Address - Phone:505-310-2114
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-06-28
Last Update Date:2024-11-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NMI-08677104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes104100000XBehavioral Health & Social Service ProvidersSocial Worker