Provider Demographics
NPI:1780129361
Name:CRUZ, JILL KRISTIN (LMFT)
Entity type:Individual
Prefix:MS
First Name:JILL
Middle Name:KRISTIN
Last Name:CRUZ
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:MS
Other - First Name:JILL
Other - Middle Name:KRISTIN
Other - Last Name:ERICKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:6100 W GILA SPRINGS PL STE 19
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:AZ
Mailing Address - Zip Code:85226-3539
Mailing Address - Country:US
Mailing Address - Phone:480-282-8778
Mailing Address - Fax:
Practice Address - Street 1:6100 W GILA SPRINGS PL STE 19
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:AZ
Practice Address - Zip Code:85226-3539
Practice Address - Country:US
Practice Address - Phone:480-282-8778
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-01-05
Last Update Date:2017-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLMFT-15175106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist