Provider Demographics
NPI:1467755322
Name:CRUSE, AMANDA J (LMFT)
Entity Type:Individual
Prefix:MRS
First Name:AMANDA
Middle Name:J
Last Name:CRUSE
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:PO BOX 1082
Mailing Address - Street 2:
Mailing Address - City:HERMOSA BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:90254-1082
Mailing Address - Country:US
Mailing Address - Phone:310-748-7837
Mailing Address - Fax:
Practice Address - Street 1:23440 HAWTHORNE BLVD
Practice Address - Street 2:SUITE 280
Practice Address - City:TORRANCE
Practice Address - State:CA
Practice Address - Zip Code:90505-4748
Practice Address - Country:US
Practice Address - Phone:310-748-7837
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-12-15
Last Update Date:2015-08-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA86247106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist