Provider Demographics
NPI:1225583602
Name:HENGGE, CYNTHIA R (CADC I)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:R
Last Name:HENGGE
Suffix:
Gender:F
Credentials:CADC I
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3445 S SHERIDAN RD
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74145-1105
Mailing Address - Country:US
Mailing Address - Phone:918-610-3366
Mailing Address - Fax:918-610-3344
Practice Address - Street 1:3445 S SHERIDAN RD
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74145-1105
Practice Address - Country:US
Practice Address - Phone:918-610-3366
Practice Address - Fax:918-610-3344
Is Sole Proprietor?:No
Enumeration Date:2016-08-16
Last Update Date:2023-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YA0400X, 171M00000X
OR16-12-17101YA0400X
OR101YM0800X
OK101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No171M00000XOther Service ProvidersCase Manager/Care Coordinator
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR500732481Medicaid
OR500717741Medicaid