Provider Demographics
NPI:1801197843
Name:CRUZ, ANGIE IZABELLE (MAE, LMHC, MHP, CMHS)
Entity Type:Individual
Prefix:MS
First Name:ANGIE
Middle Name:IZABELLE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:MAE, LMHC, MHP, CMHS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5411 E MILL PLAIN BLVD STE 4
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98661-7046
Mailing Address - Country:US
Mailing Address - Phone:360-984-3071
Mailing Address - Fax:360-823-1088
Practice Address - Street 1:5411 E MILL PLAIN BLVD STE 4
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98661-7046
Practice Address - Country:US
Practice Address - Phone:360-695-2823
Practice Address - Fax:360-823-1088
Is Sole Proprietor?:No
Enumeration Date:2010-11-08
Last Update Date:2018-12-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MA8410101YM0800X
WALH 60455158101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MA8410OtherLMHC
WALH60455158OtherLMHC
WA2000011Medicaid