Healthcare Provider Details

I. General information

NPI: 1760883672
Provider Name (Legal Business Name): TARA CRUISE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/10/2014
Last Update Date: 08/13/2026
Certification Date: 08/13/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10 CIRCLE DR STE 6
NORTH LIBERTY IA
52317-8818
US

IV. Provider business mailing address

4408 WENIG RD NE
CEDAR RAPIDS IA
52402-2211
US

V. Phone/Fax

Practice location:
  • Phone: 319-270-9545
  • Fax:
Mailing address:
  • Phone: 319-270-9545
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number000403
License Number StateIA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: