Provider Demographics
NPI:1215486345
Name:CROSS, SHELLY (LMFT)
Entity type:Individual
Prefix:
First Name:SHELLY
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3 RIVER ST
Mailing Address - Street 2:
Mailing Address - City:PETERBOROUGH
Mailing Address - State:NH
Mailing Address - Zip Code:03458-1405
Mailing Address - Country:US
Mailing Address - Phone:603-340-4570
Mailing Address - Fax:
Practice Address - Street 1:174 CONCORD ST STE 280
Practice Address - Street 2:
Practice Address - City:PETERBOROUGH
Practice Address - State:NH
Practice Address - Zip Code:03458-1222
Practice Address - Country:US
Practice Address - Phone:603-924-3644
Practice Address - Fax:603-924-7420
Is Sole Proprietor?:No
Enumeration Date:2016-09-30
Last Update Date:2020-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
390200000X
NH246106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No390200000XStudent, Health CareStudent in an Organized Health Care Education/Training Program