1760722706 NPI number — CYNTHIA A UNGER MA, LPCC, LPC

Table of content: (NPI 1508892381)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1760722706 NPI number — CYNTHIA A UNGER MA, LPCC, LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
UNGER
Provider First Name:
CYNTHIA
Provider Middle Name:
A
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MA, LPCC, LPC
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:
1760722706
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/23/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
55 LAKE HAVASU AVE S STE F713
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKE HAVASU CITY
Provider Business Mailing Address State Name:
AZ
Provider Business Mailing Address Postal Code:
86403-0938
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
505-278-0552
Provider Business Mailing Address Fax Number:
505-544-2593

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
276 LAKE HAVASU AVE S STE A9-A
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKE HAVASU CITY
Provider Business Practice Location Address State Name:
AZ
Provider Business Practice Location Address Postal Code:
86403-0851
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
928-275-4144
Provider Business Practice Location Address Fax Number:
505-544-2593
Provider Enumeration Date:
02/28/2013

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: 101YP2500X , with the licence number:  CCMH0175441 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 101YP2500X , with the licence number: 0175441 , registered in the state of NM ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 101YP2500X , with the licence number: LPC-19375 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 18853081 , issued by the state of ( NM ) . This identifiers is of the category "MEDICAID".