MEDICARE: LUISA F MARTINEZ-CRUZ LMFT, LADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	01249	NV
2	106H00000X	Marriage & Family Therapist	MI#0532	NV

General Provider Information

NPI Number	:	1255777272
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	LUISA F MARTINEZ-CRUZ LMFT, LADC

Provider Business Mailing Address
First Line	:	7271 W CHARLESTON BLVD STE 180
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1684
Country	:	US
Telephone Number	:	702-747-9499
Fax Number	:	702-912-0298

Provider Business Practice Location Address
First Line	:	7271 W CHARLESTON BLVD STE 180
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89117-1684
Country	:	US
Telephone Number	:	702-747-9499
Fax Number	:	702-912-0298

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/16/2013
Last Update Date	:	07/20/2020

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