Primary | Taxonomy Code | Taxonomy Specialty | License Number | License State |
---|---|---|---|---|
Y | 101YM0800X | Mental Health Counselor | MH 10245 | FL |
N | 103K00000X | Behavior Analyst | 0041234 | FL |
NPI | 1013245893 |
---|---|
Provider Name | Ms. Kimberly Lintner Cruise |
First Address | Jacksonville, FL 32210-4167 |
Second Address | Jacksonville, FL 32210 |
Gender | F |
NPI Entity type | Individual |
Is Sole Proprietor | Yes |
Is Organization Subpart | N/A |
Enumeration Date | 07/12/2009 |
Last Update Date | 07/09/2018 |