Provider Demographics
NPI:1407463409
Name:CRUZ, CYNTHIA (MA, MFTC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MA, MFTC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11304 BERRY FARM RD
Mailing Address - Street 2:
Mailing Address - City:FOUNTAIN
Mailing Address - State:CO
Mailing Address - Zip Code:80817-4214
Mailing Address - Country:US
Mailing Address - Phone:719-651-6573
Mailing Address - Fax:
Practice Address - Street 1:7710 N. UNION
Practice Address - Street 2:STE 100B AND 100C
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80920
Practice Address - Country:US
Practice Address - Phone:719-651-6573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-09-24
Last Update Date:2020-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0014040106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist