Provider Demographics
NPI:1790319952
Name:CRUZ, ANA GREICY (MA)
Entity Type:Individual
Prefix:
First Name:ANA
Middle Name:GREICY
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:17618 PEARL ST
Mailing Address - Street 2:
Mailing Address - City:BAILEY
Mailing Address - State:MI
Mailing Address - Zip Code:49303-9750
Mailing Address - Country:US
Mailing Address - Phone:231-245-4362
Mailing Address - Fax:
Practice Address - Street 1:1061 S GETTY ST
Practice Address - Street 2:
Practice Address - City:MUSKEGON
Practice Address - State:MI
Practice Address - Zip Code:49442-4066
Practice Address - Country:US
Practice Address - Phone:231-722-7980
Practice Address - Fax:231-722-7979
Is Sole Proprietor?:Yes
Enumeration Date:2020-02-26
Last Update Date:2020-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MIP220644101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health