Provider Demographics
NPI:1811012537
Name:CRUZ, CAROL LOUISE (LMFT)
Entity Type:Individual
Prefix:
First Name:CAROL
Middle Name:LOUISE
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4126 S DEMAREE ST
Mailing Address - Street 2:SUITE B
Mailing Address - City:VISALIA
Mailing Address - State:CA
Mailing Address - Zip Code:93277-9514
Mailing Address - Country:US
Mailing Address - Phone:559-393-7465
Mailing Address - Fax:
Practice Address - Street 1:4034 S DEMAREE ST
Practice Address - Street 2:
Practice Address - City:VISALIA
Practice Address - State:CA
Practice Address - Zip Code:93277-9476
Practice Address - Country:US
Practice Address - Phone:559-393-7465
Practice Address - Fax:559-738-0710
Is Sole Proprietor?:No
Enumeration Date:2007-03-20
Last Update Date:2023-06-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA52643106H00000X
CA52895101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health