Provider Demographics
NPI:1023636453
Name:CALZADA-SANTACRUZ, LOURDES (MFT-I)
Entity type:Individual
Prefix:
First Name:LOURDES
Middle Name:
Last Name:CALZADA-SANTACRUZ
Suffix:
Gender:F
Credentials:MFT-I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 TERMINAL WAY
Mailing Address - Street 2:ST. 100
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89502
Mailing Address - Country:US
Mailing Address - Phone:775-234-8551
Mailing Address - Fax:
Practice Address - Street 1:1201 TERMINAL WAY
Practice Address - Street 2:ST. 100
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89502
Practice Address - Country:US
Practice Address - Phone:775-234-8551
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2020-07-13
Last Update Date:2020-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI2894106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist