Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
N | 103G00000X | Clinical Psychologist | 9369974-2501 | UT |
N | 103TC0700X | Clinical Psychologist | 9369974-2501 | UT |
Y | 103TC2200X | Clinical Child & Adolescent Psychologist | 9369974-2501 | UT |
NPI | 1063044865 |
---|---|
Provider Name | Dr. Rick Anthony Cruz |
First Address | Logan, UT 84321-4828 |
Second Address | Logan, UT 84322-6405 |
Gender | M |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 10/02/2020 |
Last Update Date | 10/02/2020 |