Provider Demographics
NPI:1629806211
Name:CRUCES, JENALYSSA E (MA, AMFT)
Entity type:Individual
Prefix:
First Name:JENALYSSA
Middle Name:E
Last Name:CRUCES
Suffix:
Gender:F
Credentials:MA, AMFT
Other - Prefix:
Other - First Name:JENA
Other - Middle Name:
Other - Last Name:CRUCES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:791 8TH ST STE S
Mailing Address - Street 2:
Mailing Address - City:ARCATA
Mailing Address - State:CA
Mailing Address - Zip Code:95521-6234
Mailing Address - Country:US
Mailing Address - Phone:707-572-4573
Mailing Address - Fax:
Practice Address - Street 1:791 8TH ST STE S
Practice Address - Street 2:
Practice Address - City:ARCATA
Practice Address - State:CA
Practice Address - Zip Code:95521-6234
Practice Address - Country:US
Practice Address - Phone:707-572-4573
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-07-24
Last Update Date:2024-07-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA148086101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health