Provider Demographics
NPI:1700608072
Name:CRUZ, JORGE ANTONIO JR (LPC)
Entity type:Individual
Prefix:MR
First Name:JORGE
Middle Name:ANTONIO
Last Name:CRUZ
Suffix:JR
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 DOUGLAS AVE
Mailing Address - Street 2:
Mailing Address - City:ELGIN
Mailing Address - State:IL
Mailing Address - Zip Code:60120-3633
Mailing Address - Country:US
Mailing Address - Phone:956-844-2691
Mailing Address - Fax:
Practice Address - Street 1:73 S RIVERSIDE DR FL 3
Practice Address - Street 2:
Practice Address - City:ELGIN
Practice Address - State:IL
Practice Address - Zip Code:60120-6452
Practice Address - Country:US
Practice Address - Phone:847-243-6458
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-10-29
Last Update Date:2024-10-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL178.020544101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health