Provider Demographics
NPI:1619429974
Name:CRUZ, GRIZEL (LMHC)
Entity Type:Individual
Prefix:
First Name:GRIZEL
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 OAKFIELD DR STE 114
Mailing Address - Street 2:
Mailing Address - City:BRANDON
Mailing Address - State:FL
Mailing Address - Zip Code:33511-4948
Mailing Address - Country:US
Mailing Address - Phone:813-385-8721
Mailing Address - Fax:
Practice Address - Street 1:1111 OAKFIELD DR STE 114
Practice Address - Street 2:
Practice Address - City:BRANDON
Practice Address - State:FL
Practice Address - Zip Code:33511-4948
Practice Address - Country:US
Practice Address - Phone:813-385-8721
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2016-11-02
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH4665101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health