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General NPI Number Information
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NPI Number | 1295147445
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Entity Type | Individual
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Provider Name | YANCY CRUZ
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Gender | Female
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Dates
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Enumeration Date | 05/22/2014
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Last Update Date | 12/11/2025
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Provider Practice Location Address
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Address Line | 310 S PLOVER DR
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City | CARBONDALE
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State | IL
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Zip | 62901-2030
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Country | US
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Telephone | 787-372-4808
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 3411
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City | CARBONDALE
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State | IL
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Zip | 62902-3411
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Country | US
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Telephone | 787-372-4808
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 180.016962
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License Number State | IL
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