Provider Demographics
NPI:1235447897
Name:ANDERSON, CYNTHIA ELAINE (LMFT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ELAINE
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2130 MAIN ST STE 120
Mailing Address - Street 2:
Mailing Address - City:HUNTINGTON BEACH
Mailing Address - State:CA
Mailing Address - Zip Code:92648-6476
Mailing Address - Country:US
Mailing Address - Phone:714-264-6659
Mailing Address - Fax:
Practice Address - Street 1:2130 MAIN ST STE 120
Practice Address - Street 2:
Practice Address - City:HUNTINGTON BEACH
Practice Address - State:CA
Practice Address - Zip Code:92648-6476
Practice Address - Country:US
Practice Address - Phone:714-264-6659
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-09-16
Last Update Date:2016-11-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT53280106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist