Provider Demographics
NPI:1104217678
Name:HERBERT, CYNTHIA (MS)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:HERBERT
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:130 MARVIN RD SE STE 120
Mailing Address - Street 2:
Mailing Address - City:LACEY
Mailing Address - State:WA
Mailing Address - Zip Code:98503-6101
Mailing Address - Country:US
Mailing Address - Phone:360-999-3318
Mailing Address - Fax:
Practice Address - Street 1:130 MARVIN RD SE STE 120
Practice Address - Street 2:
Practice Address - City:LACEY
Practice Address - State:WA
Practice Address - Zip Code:98503-6101
Practice Address - Country:US
Practice Address - Phone:360-999-3318
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-02-05
Last Update Date:2023-03-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101Y00000X
WALH 60626685101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101Y00000XBehavioral Health & Social Service ProvidersCounselor