Provider Demographics
NPI:1366839904
Name:CRUZ, CRESENCIA VIRGINIA (LMFT)
Entity Type:Individual
Prefix:
First Name:CRESENCIA
Middle Name:VIRGINIA
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1157 COLOMBARD DR
Mailing Address - Street 2:
Mailing Address - City:MADERA
Mailing Address - State:CA
Mailing Address - Zip Code:93637-5731
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1551 E SHAW AVE STE 139
Practice Address - Street 2:
Practice Address - City:FRESNO
Practice Address - State:CA
Practice Address - Zip Code:93710-8025
Practice Address - Country:US
Practice Address - Phone:559-320-0490
Practice Address - Fax:559-320-0494
Is Sole Proprietor?:Yes
Enumeration Date:2015-04-21
Last Update Date:2020-02-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA107963106H00000X
CAIMF81576106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist