Provider Demographics
NPI:1205932936
Name:SPAIN, JULIA CRUZ (LPC)
Entity type:Individual
Prefix:MS
First Name:JULIA
Middle Name:CRUZ
Last Name:SPAIN
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1235 S PUEBLO CT
Mailing Address - Street 2:
Mailing Address - City:GILBERT
Mailing Address - State:AZ
Mailing Address - Zip Code:85233-8343
Mailing Address - Country:US
Mailing Address - Phone:480-812-3059
Mailing Address - Fax:
Practice Address - Street 1:633 E RAY RD
Practice Address - Street 2:SUITE 107
Practice Address - City:GILBERT
Practice Address - State:AZ
Practice Address - Zip Code:85296-4200
Practice Address - Country:US
Practice Address - Phone:602-697-1023
Practice Address - Fax:480-422-5611
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-16
Last Update Date:2008-04-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-11141101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional