Provider Demographics
NPI:1033304738
Name:GRANADOS, CYNTHIA ANNE (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANNE
Last Name:GRANADOS
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1800 NE LOOP 410 STE 209
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78217-5210
Mailing Address - Country:US
Mailing Address - Phone:210-832-0701
Mailing Address - Fax:210-697-9706
Practice Address - Street 1:1800 NE LOOP 410 STE 209
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78217-5210
Practice Address - Country:US
Practice Address - Phone:210-832-0701
Practice Address - Fax:210-697-9706
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-06
Last Update Date:2017-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX200994106H00000X
TX61842101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX200994OtherLMFT
TX61842OtherLPC