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General NPI Number Information
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NPI Number | 1407212061
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Entity Type | Individual
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Provider Name | MICHELE MCCULLOUGH-CRUZ LMSW
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Gender | Female
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Dates
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Enumeration Date | 01/12/2016
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Last Update Date | 01/15/2021
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Provider Practice Location Address
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Address Line | 1263 W CALLE DE LA PLZ
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City | SAHUARITA
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State | AZ
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Zip | 85629-9730
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Country | US
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Telephone | 520-437-2561
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Fax |
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Provider Business Mailing Address
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Address Line | 815 W VIA RANCHO SAHUARITA UNIT 239
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City | SAHUARITA
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State | AZ
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Zip | 85629-1109
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Country | US
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Telephone | 520-437-2561
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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 | 1041C0700X
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Taxonomy Name | Clinical Social Worker
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License Number | 15751
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License Number State | AZ
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