Provider Demographics
NPI:1093736589
Name:HORACEK, CYNTHIA R (MFT)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:R
Last Name:HORACEK
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:30423 CANWOOD ST STE 129
Mailing Address - Street 2:
Mailing Address - City:AGOURA HILLS
Mailing Address - State:CA
Mailing Address - Zip Code:91301-4315
Mailing Address - Country:US
Mailing Address - Phone:818-706-1055
Mailing Address - Fax:
Practice Address - Street 1:30423 CANWOOD ST STE 129
Practice Address - Street 2:
Practice Address - City:AGOURA HILLS
Practice Address - State:CA
Practice Address - Zip Code:91301-4315
Practice Address - Country:US
Practice Address - Phone:818-706-1055
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 35890106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist