MEDICARE: ANTONIO CRUZLMH LMHC

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	101YM0800X	Mental Health Counselor	MH8099	FL
2	225400000X	Rehabilitation Practitioner
3	251B00000X	Case Management Agency
4	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1487883997
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ANTONIO CRUZLMH LMHC

Provider Business Mailing Address
First Line	:	263 SPRING HOLLOW DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2502
Country	:	US
Telephone Number	:	954-461-4282
Fax Number	:

Provider Business Practice Location Address
First Line	:	263 SPRING HOLLOW DR
Second Line	:
City	:	LAS VEGAS
State	:	NV
Zip	:	89148-2502
Country	:	US
Telephone Number	:	954-461-4282
Fax Number	:

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

Provider Enumeration Date	:	07/06/2009
Last Update Date	:	05/02/2017

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