Provider Demographics
NPI:1962929034
Name:CROSS, LESLEY A
Entity type:Individual
Prefix:
First Name:LESLEY
Middle Name:A
Last Name:CROSS
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 1:494 MID DR
Mailing Address - Street 2:
Mailing Address - City:WORTHINGTON
Mailing Address - State:OH
Mailing Address - Zip Code:43085-3822
Mailing Address - Country:US
Mailing Address - Phone:614-271-2289
Mailing Address - Fax:
Practice Address - Street 1:870 HIGH ST STE 203
Practice Address - Street 2:
Practice Address - City:WORTHINGTON
Practice Address - State:OH
Practice Address - Zip Code:43085-4139
Practice Address - Country:US
Practice Address - Phone:614-284-8922
Practice Address - Fax:614-284-8922
Is Sole Proprietor?:No
Enumeration Date:2017-08-29
Last Update Date:2019-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHE.1800655101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional