Provider Demographics
NPI:1972181121
Name:CRUISE, CHARLES E JR (MA)
Entity Type:Individual
Prefix:
First Name:CHARLES
Middle Name:E
Last Name:CRUISE
Suffix:JR
Gender:M
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 N WASHINGTON ST APT F
Mailing Address - Street 2:
Mailing Address - City:WHEATON
Mailing Address - State:IL
Mailing Address - Zip Code:60187-5333
Mailing Address - Country:US
Mailing Address - Phone:224-230-7595
Mailing Address - Fax:
Practice Address - Street 1:1737 S NAPERVILLE RD STE 200
Practice Address - Street 2:
Practice Address - City:WHEATON
Practice Address - State:IL
Practice Address - Zip Code:60189-5894
Practice Address - Country:US
Practice Address - Phone:630-653-9700
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-03-30
Last Update Date:2021-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor