Provider Demographics
NPI:1881454510
Name:CRUZ AVILA, KATRINA AMANDA MARIE
Entity type:Individual
Prefix:
First Name:KATRINA
Middle Name:AMANDA MARIE
Last Name:CRUZ AVILA
Suffix:
Gender:F
Credentials:
Other - Prefix:MRS
Other - First Name:KATRINA
Other - Middle Name:AMANDA MARIE
Other - Last Name:JOSEPH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LMHCA
Mailing Address - Street 1:116 N BOWDISH RD APT C
Mailing Address - Street 2:
Mailing Address - City:SPOKANE VALLEY
Mailing Address - State:WA
Mailing Address - Zip Code:99206-5183
Mailing Address - Country:US
Mailing Address - Phone:406-210-7666
Mailing Address - Fax:
Practice Address - Street 1:1803 W MAXWELL AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99201-2831
Practice Address - Country:US
Practice Address - Phone:509-325-5502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2024-03-20
Last Update Date:2025-10-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WAMC61525501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health