1689080285 NPI number — CYNTHIA ANN ANDERSON MED, LPC, CSC

Table of content: CYNTHIA ANN ANDERSON MED, LPC, CSC (NPI 1689080285)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1689080285 NPI number — CYNTHIA ANN ANDERSON MED, LPC, CSC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
ANDERSON
Provider First Name:
CYNTHIA
Provider Middle Name:
ANN
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MED, LPC, CSC
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:
1689080285
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/03/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 3245
Provider Second Line Business Mailing Address:
NONE
Provider Business Mailing Address City Name:
BANDERA
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
78003-3245
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
830-796-8488
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
503 NINTH ST.
Provider Second Line Business Practice Location Address:
NONE
Provider Business Practice Location Address City Name:
BANDERA
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
78003
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
830-796-8488
Provider Business Practice Location Address Fax Number:
830-796-8488
Provider Enumeration Date:
07/03/2014

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: 101Y00000X , with the licence number:  14989 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 101Y00000X , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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