Provider Demographics
NPI:1407212061
Name:MCCULLOUGH-CRUZ, MICHELE (LMSW)
Entity Type:Individual
Prefix:
First Name:MICHELE
Middle Name:
Last Name:MCCULLOUGH-CRUZ
Suffix:
Gender:F
Credentials:LMSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:815 W VIA RANCHO SAHUARITA UNIT 239
Mailing Address - Street 2:
Mailing Address - City:SAHUARITA
Mailing Address - State:AZ
Mailing Address - Zip Code:85629-1109
Mailing Address - Country:US
Mailing Address - Phone:520-437-2561
Mailing Address - Fax:
Practice Address - Street 1:1263 W CALLE DE LA PLZ
Practice Address - Street 2:
Practice Address - City:SAHUARITA
Practice Address - State:AZ
Practice Address - Zip Code:85629-9730
Practice Address - Country:US
Practice Address - Phone:520-437-2561
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-01-12
Last Update Date:2021-01-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ157511041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical