Provider Demographics
NPI:1447701990
Name:CROSS, SHELBRA
Entity type:Individual
Prefix:
First Name:SHELBRA
Middle Name:
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 1:525 MORRIS ST
Mailing Address - Street 2:
Mailing Address - City:FRANKLIN
Mailing Address - State:LA
Mailing Address - Zip Code:70538-6604
Mailing Address - Country:US
Mailing Address - Phone:337-828-0855
Mailing Address - Fax:
Practice Address - Street 1:525 MORRIS ST
Practice Address - Street 2:
Practice Address - City:FRANKLIN
Practice Address - State:LA
Practice Address - Zip Code:70538-6604
Practice Address - Country:US
Practice Address - Phone:337-828-0855
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-10-19
Last Update Date:2022-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
LA3682235Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes235Z00000XSpeech, Language and Hearing Service ProvidersSpeech-Language Pathologist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health