Provider Demographics
NPI:1629474747
Name:CRUZ, LILLIANIS JALIERIS (LMHC)
Entity Type:Individual
Prefix:
First Name:LILLIANIS
Middle Name:JALIERIS
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 1:241 RUBY AVE STE B
Mailing Address - Street 2:
Mailing Address - City:KISSIMMEE
Mailing Address - State:FL
Mailing Address - Zip Code:34741-5627
Mailing Address - Country:US
Mailing Address - Phone:407-978-0432
Mailing Address - Fax:
Practice Address - Street 1:241 RUBY AVE STE B
Practice Address - Street 2:
Practice Address - City:KISSIMMEE
Practice Address - State:FL
Practice Address - Zip Code:34741-5627
Practice Address - Country:US
Practice Address - Phone:407-978-0432
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-11-17
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14082101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL016903800Medicaid