Provider Demographics
NPI:1003092412
Name:CYNTHEA CUNNINGHAMM
Entity Type:Organization
Organization Name:CYNTHEA CUNNINGHAMM
Other - Org Name:CYNTHEA CUNNINGHAMM, MS
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHEA
Authorized Official - Middle Name:ANNE
Authorized Official - Last Name:CUNNINGHAMM
Authorized Official - Suffix:
Authorized Official - Credentials:MS
Authorized Official - Phone:509-838-3221
Mailing Address - Street 1:323 W 15TH AVE
Mailing Address - Street 2:
Mailing Address - City:SPOKANE
Mailing Address - State:WA
Mailing Address - Zip Code:99203-2107
Mailing Address - Country:US
Mailing Address - Phone:509-838-3221
Mailing Address - Fax:
Practice Address - Street 1:323 W 15TH AVE
Practice Address - Street 2:
Practice Address - City:SPOKANE
Practice Address - State:WA
Practice Address - Zip Code:99203-2107
Practice Address - Country:US
Practice Address - Phone:509-838-3221
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-15
Last Update Date:2008-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00004671251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health