Provider Demographics
NPI:1487894598
Name:CROSS, ANGELA (MA)
Entity type:Individual
Prefix:MS
First Name:ANGELA
Middle Name:
Last Name:CROSS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:200 1ST AVE W STE 400
Mailing Address - Street 2:
Mailing Address - City:SEATTLE
Mailing Address - State:WA
Mailing Address - Zip Code:98119-4219
Mailing Address - Country:US
Mailing Address - Phone:425-361-7987
Mailing Address - Fax:206-902-9688
Practice Address - Street 1:200 1ST AVE W STE 400
Practice Address - Street 2:
Practice Address - City:SEATTLE
Practice Address - State:WA
Practice Address - Zip Code:98119-4219
Practice Address - Country:US
Practice Address - Phone:425-361-7987
Practice Address - Fax:206-902-9688
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-02
Last Update Date:2020-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH60284453101YM0800X
WA251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1487894598OtherNPI