Basic Information
| Provider Information | |||||||||
| NPI: | 1477936185 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | CROSS | ||||||||
| FirstName: | GINA | ||||||||
| MiddleName: | DIANE | ||||||||
| NamePrefix: | MS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | BCBA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 6516 BROADWAY ST STE 112 | ||||||||
| Address2: | |||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775817879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3039898169 | ||||||||
| FaxNumber: | |||||||||
| Practice Location | |||||||||
| Address1: | 6516 BROADWAY ST STE 112 | ||||||||
| Address2: | |||||||||
| City: | PEARLAND | ||||||||
| State: | TX | ||||||||
| PostalCode: | 775817879 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7202196453 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/30/2015 | ||||||||
| LastUpdateDate: | 02/04/2020 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 02/04/2020 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 103K00000X | 1-15-18699 | TX | Y | Behavioral Health & Social Service Providers | Behavioral Analyst |
No ID Information.