Provider Demographics
NPI:1053635540
Name:WILLIAMS, CYNTHIA LYNN (MA)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LYNN
Last Name:WILLIAMS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:MRS
Other - First Name:CYNTHIA
Other - Middle Name:LYNN
Other - Last Name:FANCHER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MA
Mailing Address - Street 1:660 MORTHLAND DR STE D
Mailing Address - Street 2:
Mailing Address - City:VALPARAISO
Mailing Address - State:IN
Mailing Address - Zip Code:46385-4638
Mailing Address - Country:US
Mailing Address - Phone:219-462-9200
Mailing Address - Fax:
Practice Address - Street 1:660 MORTHLAND DR STE D
Practice Address - Street 2:
Practice Address - City:VALPARAISO
Practice Address - State:IN
Practice Address - Zip Code:46385-4638
Practice Address - Country:US
Practice Address - Phone:219-462-9200
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2010-03-26
Last Update Date:2021-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN39003313A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
INCA143Medicaid