Provider Demographics
NPI:1366324220
Name:CRUZ, BETHDALIE (PHD)
Entity type:Individual
Prefix:DR
First Name:BETHDALIE
Middle Name:
Last Name:CRUZ
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5855 BOURKE DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80919-2448
Mailing Address - Country:US
Mailing Address - Phone:414-339-6988
Mailing Address - Fax:
Practice Address - Street 1:5525 ERINDALE DR STE 217C
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80918-6962
Practice Address - Country:US
Practice Address - Phone:719-413-6930
Practice Address - Fax:719-247-3940
Is Sole Proprietor?:No
Enumeration Date:2025-07-22
Last Update Date:2025-07-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COPSYC.00016087103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist