Provider Demographics
NPI:1023373222
Name:CRUZ, J MICHAEL (LPC-INTERN)
Entity Type:Individual
Prefix:DR
First Name:J
Middle Name:MICHAEL
Last Name:CRUZ
Suffix:
Gender:M
Credentials:LPC-INTERN
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4054 MCKINNEY AVE STE 102
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75204-2050
Mailing Address - Country:US
Mailing Address - Phone:469-500-0227
Mailing Address - Fax:
Practice Address - Street 1:4054 MCKINNEY AVE STE 102
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75204-2050
Practice Address - Country:US
Practice Address - Phone:469-500-0227
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-07-12
Last Update Date:2012-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69482101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health