Healthcare Provider Details

I. General information

NPI: 1801541776
Provider Name (Legal Business Name): MELISSA MARIE CRUZ LMHC, MSED
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 02/18/2022
Last Update Date: 02/18/2022
Certification Date: 02/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12651 S DIXIE HWY STE 402
PINECREST FL
33156-5956
US

IV. Provider business mailing address

4580 SW 68TH COURT CIR APT 7
MIAMI FL
33155-6816
US

V. Phone/Fax

Practice location:
  • Phone: 786-808-4673
  • Fax:
Mailing address:
  • Phone: 305-815-0750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH20331
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: