Provider Demographics
NPI:1144399874
Name:PEVETO, CYNTHIA A (PHD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:A
Last Name:PEVETO
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3201 TEASLEY LN
Mailing Address - Street 2:STE 303
Mailing Address - City:DENTON
Mailing Address - State:TX
Mailing Address - Zip Code:76210-8302
Mailing Address - Country:US
Mailing Address - Phone:940-383-8282
Mailing Address - Fax:940-565-8170
Practice Address - Street 1:3201 TEASLEY LN
Practice Address - Street 2:STE 303
Practice Address - City:DENTON
Practice Address - State:TX
Practice Address - Zip Code:76210-8302
Practice Address - Country:US
Practice Address - Phone:940-383-8282
Practice Address - Fax:940-565-8170
Is Sole Proprietor?:No
Enumeration Date:2006-11-07
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX31077103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8G1386Medicare ID - Type UnspecifiedDENTON
TX8G1387Medicare ID - Type UnspecifiedDALLAS