1720607864 NPI number — CYNTHIA DENEASE NEWSOM LPC, DBTT, LCDC

Table of content: CYNTHIA DENEASE NEWSOM LPC, DBTT, LCDC (NPI 1720607864)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1720607864 NPI number — CYNTHIA DENEASE NEWSOM LPC, DBTT, LCDC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
NEWSOM
Provider First Name:
CYNTHIA
Provider Middle Name:
DENEASE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC, DBTT, LCDC
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:
1720607864
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/09/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
29202 MCKINNON RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
RICHMOND
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77406-9798
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
832-729-9583
Provider Business Mailing Address Fax Number:
281-346-2242

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
29202 MCKINNON RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
RICHMOND
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77406-9798
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
832-729-9583
Provider Business Practice Location Address Fax Number:
281-346-2242
Provider Enumeration Date:
04/09/2020

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: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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