Provider Demographics
NPI:1235351933
Name:OTTERNESS, CINDY
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:OTTERNESS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12134 STALLION WAY
Mailing Address - Street 2:
Mailing Address - City:TRUCKEE
Mailing Address - State:CA
Mailing Address - Zip Code:96161-1451
Mailing Address - Country:US
Mailing Address - Phone:530-587-8194
Mailing Address - Fax:530-587-5617
Practice Address - Street 1:10015 PALISADES DR STE 1
Practice Address - Street 2:
Practice Address - City:TRUCKEE
Practice Address - State:CA
Practice Address - Zip Code:96161-1941
Practice Address - Country:US
Practice Address - Phone:530-587-5194
Practice Address - Fax:530-587-5617
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)