Provider Demographics
NPI:1134557762
Name:CRUZ, WILLIAM R (MA, LMFT)
Entity type:Individual
Prefix:
First Name:WILLIAM R
Middle Name:
Last Name:CRUZ
Suffix:
Gender:M
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10628 58TH ST E
Mailing Address - Street 2:
Mailing Address - City:PARRISH
Mailing Address - State:FL
Mailing Address - Zip Code:34219-4524
Mailing Address - Country:US
Mailing Address - Phone:813-480-1118
Mailing Address - Fax:
Practice Address - Street 1:14920 BALM WIMAUMA RD
Practice Address - Street 2:
Practice Address - City:WIMAUMA
Practice Address - State:FL
Practice Address - Zip Code:33598-5500
Practice Address - Country:US
Practice Address - Phone:813-634-7136
Practice Address - Fax:813-633-8796
Is Sole Proprietor?:Yes
Enumeration Date:2013-10-16
Last Update Date:2013-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMT-1547106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist