Provider Demographics
NPI:1508219007
Name:CRUZ MORALES, ALICE LYDIA (LAT-396)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:LYDIA
Last Name:CRUZ MORALES
Suffix:
Gender:F
Credentials:LAT-396
Other - Prefix:
Other - First Name:ALICE
Other - Middle Name:LYDIA
Other - Last Name:ELMER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 190
Mailing Address - Street 2:
Mailing Address - City:ST STEPHENS
Mailing Address - State:WY
Mailing Address - Zip Code:82524-0190
Mailing Address - Country:US
Mailing Address - Phone:307-856-0470
Mailing Address - Fax:307-857-4383
Practice Address - Street 1:24 GREAT PLAINS ROAD
Practice Address - Street 2:
Practice Address - City:ARAPAHOE
Practice Address - State:WY
Practice Address - Zip Code:82510
Practice Address - Country:US
Practice Address - Phone:307-856-0470
Practice Address - Fax:307-857-4383
Is Sole Proprietor?:No
Enumeration Date:2016-07-20
Last Update Date:2021-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY083101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)