Provider Demographics
NPI:1013245893
Name:CRUISE, KIMBERLY LINTNER (LMHC, BCABA)
Entity type:Individual
Prefix:MS
First Name:KIMBERLY
Middle Name:LINTNER
Last Name:CRUISE
Suffix:
Gender:F
Credentials:LMHC, BCABA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2317 BLANDING BLVD STE 102
Mailing Address - Street 2:
Mailing Address - City:JACKSONVILLE
Mailing Address - State:FL
Mailing Address - Zip Code:32210-4167
Mailing Address - Country:US
Mailing Address - Phone:904-200-7979
Mailing Address - Fax:904-387-8950
Practice Address - Street 1:2317 BLANDING BLVD
Practice Address - Street 2:STE 102
Practice Address - City:JACKSONVILLE
Practice Address - State:FL
Practice Address - Zip Code:32210
Practice Address - Country:US
Practice Address - Phone:904-476-8956
Practice Address - Fax:904-387-8950
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-07
Last Update Date:2018-09-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL0041234103K00000X
FLMH 10245101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst