Provider Demographics
NPI:1679144026
Name:CRUZ, JOSE ADAM
Entity type:Individual
Prefix:
First Name:JOSE
Middle Name:ADAM
Last Name:CRUZ
Suffix:
Gender:M
Credentials:
Other - Prefix:MR
Other - First Name:ADAM
Other - Middle Name:
Other - Last Name:CRUZ
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA
Mailing Address - Street 1:933 CHEAT RD
Mailing Address - Street 2:
Mailing Address - City:MORGANTOWN
Mailing Address - State:WV
Mailing Address - Zip Code:26508-5631
Mailing Address - Country:US
Mailing Address - Phone:304-554-2292
Mailing Address - Fax:
Practice Address - Street 1:933 CHEAT RD
Practice Address - Street 2:
Practice Address - City:MORGANTOWN
Practice Address - State:WV
Practice Address - Zip Code:26508-5631
Practice Address - Country:US
Practice Address - Phone:304-554-2292
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-07
Last Update Date:2021-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WV631101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health