Provider Demographics
NPI:1164588703
Name:KIMBERLIN-FLANDERS, CYNTHIA LEIGH (LPC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LEIGH
Last Name:KIMBERLIN-FLANDERS
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 1:1877 S WOODSIDE DR
Mailing Address - Street 2:
Mailing Address - City:HOLLADAY
Mailing Address - State:UT
Mailing Address - Zip Code:84124-1630
Mailing Address - Country:US
Mailing Address - Phone:801-231-5916
Mailing Address - Fax:
Practice Address - Street 1:845 E 4800 S
Practice Address - Street 2:SUITE 200
Practice Address - City:MURRAY
Practice Address - State:UT
Practice Address - Zip Code:84107-5049
Practice Address - Country:US
Practice Address - Phone:801-264-9522
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT4913668-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
UT4913668001001OtherBLUE CROSS BLUE SHIELD