=====================================================
General NPI Number Information
=====================================================
NPI Number | 1982235545
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | NAOMI EVE CRUZ LCDC, LPC-INTERN
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/31/2020
-----------------------------------------------------
Last Update Date | 11/27/2023
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 105 KATHRYN DR BLDG 3 SUITE D
-----------------------------------------------------
City | LEWISVILLE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75067-4216
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 800-972-0643
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 5769 BELT LINE RD APT 812
-----------------------------------------------------
City | DALLAS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75254-7676
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 713-679-4378
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101YA0400X
-----------------------------------------------------
Taxonomy Name | Addiction (Substance Use Disorder) Counselor
-----------------------------------------------------
License Number | 15201
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------