Provider Demographics
NPI:1528390580
Name:CRUZ, CHRISTINA CELESTE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CHRISTINA
Middle Name:CELESTE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1600 E MAIN ST STE 212
Mailing Address - Street 2:
Mailing Address - City:ALICE
Mailing Address - State:TX
Mailing Address - Zip Code:78332-4046
Mailing Address - Country:US
Mailing Address - Phone:361-661-1379
Mailing Address - Fax:361-661-1685
Practice Address - Street 1:1600 E MAIN ST STE 212
Practice Address - Street 2:
Practice Address - City:ALICE
Practice Address - State:TX
Practice Address - Zip Code:78332-4046
Practice Address - Country:US
Practice Address - Phone:361-661-1379
Practice Address - Fax:361-661-1685
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-02
Last Update Date:2010-02-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX59476101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional