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General NPI Number Information
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NPI Number | 1801197843
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Entity Type | Individual
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Provider Name | ANGIE IZABELLE CRUZ MAE, LMHC, MHP, CMHS
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Gender | Female
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Dates
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Enumeration Date | 11/08/2010
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Last Update Date | 12/20/2018
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Provider Practice Location Address
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Address Line | 5411 E MILL PLAIN BLVD STE 4
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City | VANCOUVER
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State | WA
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Zip | 98661-7046
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Country | US
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Telephone | 360-695-2823
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Fax | 360-823-1088
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Provider Business Mailing Address
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Address Line | 5411 E MILL PLAIN BLVD STE 4
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City | VANCOUVER
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State | WA
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Zip | 98661-7046
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Country | US
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Telephone | 360-984-3071
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Fax | 360-823-1088
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 8410
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License Number State | MA
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Taxonomy #2
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | LH 60455158
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License Number State | WA
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