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NPI Code Detail

MEDICARE: MRS. HEATHER GRACE CRUZ MA, LPCC

MEDICARE: MRS. HEATHER GRACE CRUZ MA, LPCC
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
1101YP2500XProfessional CounselorCC01192MN
2101YM0800XMental Health CounselorCC01192MN

General Provider Information

NPI Number : 1861946691
Entity Type Code : Individual
Provider Name (Legal Business Name) : MRS. HEATHER GRACE CRUZ MA, LPCC
Provider Business Mailing Address
First Line : 3737 40TH AVE NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-1772
Country : US
Telephone Number : 507-288-6978
Fax Number :
Provider Business Practice Location Address
First Line : 3737 40TH AVE NW
Second Line :
City : ROCHESTER
State : MN
Zip : 55901-1772
Country : US
Telephone Number : 507-288-6978
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 08/10/2016
Last Update Date : 03/05/2024

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