Provider Demographics
NPI:1235340100
Name:REIS, CINDY TROGDEN (MA, MFT)
Entity Type:Individual
Prefix:MRS
First Name:CINDY
Middle Name:TROGDEN
Last Name:REIS
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1479 29TH PL NE
Mailing Address - Street 2:
Mailing Address - City:ISSAQUAH
Mailing Address - State:WA
Mailing Address - Zip Code:98029-3684
Mailing Address - Country:US
Mailing Address - Phone:425-677-7773
Mailing Address - Fax:425-677-7658
Practice Address - Street 1:25215 NE 52ND PL
Practice Address - Street 2:
Practice Address - City:REDMOND
Practice Address - State:WA
Practice Address - Zip Code:98053-8519
Practice Address - Country:US
Practice Address - Phone:425-868-3272
Practice Address - Fax:425-836-3084
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-24
Last Update Date:2010-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF00000870106H00000X
CAMFC29226106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
WA1235340100Medicaid