1013245893 NPI number — MS. KIMBERLY LINTNER CRUISE LMHC, BCABA

Table of content: MS. KIMBERLY LINTNER CRUISE LMHC, BCABA (NPI 1013245893)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1013245893 NPI number — MS. KIMBERLY LINTNER CRUISE LMHC, BCABA

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CRUISE
Provider First Name:
KIMBERLY
Provider Middle Name:
LINTNER
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LMHC, BCABA
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1013245893
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/07/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2317 BLANDING BLVD STE 102
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
JACKSONVILLE
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
32210-4167
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
904-200-7979
Provider Business Mailing Address Fax Number:
904-387-8950

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2317 BLANDING BLVD
Provider Second Line Business Practice Location Address:
STE 102
Provider Business Practice Location Address City Name:
JACKSONVILLE
Provider Business Practice Location Address State Name:
FL
Provider Business Practice Location Address Postal Code:
32210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
904-476-8956
Provider Business Practice Location Address Fax Number:
904-387-8950
Provider Enumeration Date:
12/07/2009

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 103K00000X , with the licence number:  0041234 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YM0800X , with the licence number: MH 10245 , registered in the state of FL ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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