Provider Demographics
NPI:1154628667
Name:NELSON, CYNTHIA LEE (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LEE
Last Name:NELSON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1014 E GILBERT AVE
Mailing Address - Street 2:
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83815-4955
Mailing Address - Country:US
Mailing Address - Phone:208-667-2392
Mailing Address - Fax:208-666-1362
Practice Address - Street 1:1014 E GILBERT AVE
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83815-4955
Practice Address - Country:US
Practice Address - Phone:208-667-2392
Practice Address - Fax:208-666-1362
Is Sole Proprietor?:Yes
Enumeration Date:2011-02-17
Last Update Date:2011-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-4099101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor