Provider Demographics
NPI:1588334585
Name:CROSSLEY, KAYCIE (LMFT)
Entity type:Individual
Prefix:
First Name:KAYCIE
Middle Name:
Last Name:CROSSLEY
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 1:434 CALEDONIA ST
Mailing Address - Street 2:
Mailing Address - City:SANTA CRUZ
Mailing Address - State:CA
Mailing Address - Zip Code:95062-3312
Mailing Address - Country:US
Mailing Address - Phone:208-514-5830
Mailing Address - Fax:
Practice Address - Street 1:434 CALEDONIA ST
Practice Address - Street 2:
Practice Address - City:SANTA CRUZ
Practice Address - State:CA
Practice Address - Zip Code:95062-3312
Practice Address - Country:US
Practice Address - Phone:208-514-5830
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-20
Last Update Date:2024-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA129627106H00000X, 106H00000X
CA101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101Y00000XBehavioral Health & Social Service ProvidersCounselor