Provider Demographics
NPI:1013131267
Name:DR. MARIA B. CRUSE APMG
Entity Type:Organization
Organization Name:DR. MARIA B. CRUSE APMG
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:B
Authorized Official - Last Name:CRUSE
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:985-493-9304
Mailing Address - Street 1:604 N ACADIA RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:THIBODAUX
Mailing Address - State:LA
Mailing Address - Zip Code:70301-4847
Mailing Address - Country:US
Mailing Address - Phone:985-493-9304
Mailing Address - Fax:985-493-9305
Practice Address - Street 1:604 NORTH ACADIA ROAD
Practice Address - Street 2:SUITE 201
Practice Address - City:THIBODAUX
Practice Address - State:LA
Practice Address - Zip Code:70301
Practice Address - Country:US
Practice Address - Phone:985-493-9304
Practice Address - Fax:985-493-9305
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-12
Last Update Date:2008-06-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA09188R103TP0016X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP0016XBehavioral Health & Social Service ProvidersPsychologistPrescribing (Medical)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1650421Medicaid
LA1152919Medicaid
LA1650421Medicaid
LA1152919Medicaid