Provider Demographics
NPI:1992937452
Name:CROSS, MICHELLE (LCSW, RD,LD)
Entity type:Individual
Prefix:
First Name:MICHELLE
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:LCSW, RD,LD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2308 LAKE AUSTIN BLVD
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78703-4546
Mailing Address - Country:US
Mailing Address - Phone:512-469-7676
Mailing Address - Fax:512-236-1774
Practice Address - Street 1:4810B SPICEWOOD SPRINGS RD
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759
Practice Address - Country:US
Practice Address - Phone:512-633-2771
Practice Address - Fax:512-346-8509
Is Sole Proprietor?:No
Enumeration Date:2009-08-18
Last Update Date:2009-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX02455133V00000X
TX369401041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No133V00000XDietary & Nutritional Service ProvidersDietitian, Registered