Provider Demographics
NPI:1205201878
Name:CRUZE, KYLE BUDDY JR (MMFT)
Entity Type:Individual
Prefix:
First Name:KYLE
Middle Name:BUDDY
Last Name:CRUZE
Suffix:JR
Gender:M
Credentials:MMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:609 DURRETT DR
Mailing Address - Street 2:
Mailing Address - City:NASHVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37211-5201
Mailing Address - Country:US
Mailing Address - Phone:865-228-1897
Mailing Address - Fax:
Practice Address - Street 1:9005 OVERLOOK BLVD
Practice Address - Street 2:SUITE 138
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-5269
Practice Address - Country:US
Practice Address - Phone:865-228-1897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-08
Last Update Date:2015-12-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN1215106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist