Individual
KRISILEE KAY CRUZ
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
ISAS
Contact information
Practice address
2275 W BROADWAY ST STE G, IDAHO FALLS, ID 83402-2902
(208) 524-7400
(208) 524-8004
Mailing address
2275 W BROADWAY ST STE G, IDAHO FALLS, ID 83402-2902
(208) 524-7400
(208) 524-8004
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
Primary
10228
ID
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
0001256907
—
ID
Enumeration date
06/11/2015
Last updated
06/11/2015
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