Provider Demographics
NPI:1871519397
Name:CROSS, LISA D (MA, LMFT)
Entity type:Individual
Prefix:
First Name:LISA
Middle Name:D
Last Name:CROSS
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:7270 FORESTVIEW LN N
Mailing Address - Street 2:SUITE 150
Mailing Address - City:MAPLE GROVE
Mailing Address - State:MN
Mailing Address - Zip Code:55369-5546
Mailing Address - Country:US
Mailing Address - Phone:763-416-4167
Mailing Address - Fax:763-416-4137
Practice Address - Street 1:7270 FORESTVIEW LN N
Practice Address - Street 2:SUITE 150
Practice Address - City:MAPLE GROVE
Practice Address - State:MN
Practice Address - Zip Code:55369-5546
Practice Address - Country:US
Practice Address - Phone:763-416-4167
Practice Address - Fax:763-416-4137
Is Sole Proprietor?:No
Enumeration Date:2006-07-15
Last Update Date:2009-07-29
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
MN1359106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN397152000Medicaid