Provider Demographics
NPI:1245388404
Name:TOTTY-HEFLEY, CYNTHIA LYNN (MS)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LYNN
Last Name:TOTTY-HEFLEY
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:LYNN
Other - Last Name:BAHR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS
Mailing Address - Street 1:PO BOX 2200
Mailing Address - Street 2:
Mailing Address - City:PAHOA
Mailing Address - State:HI
Mailing Address - Zip Code:96778-2200
Mailing Address - Country:US
Mailing Address - Phone:808-365-6320
Mailing Address - Fax:
Practice Address - Street 1:622 HINANO ST
Practice Address - Street 2:
Practice Address - City:HILO
Practice Address - State:HI
Practice Address - Zip Code:96720-4427
Practice Address - Country:US
Practice Address - Phone:808-589-1829
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-01-06
Last Update Date:2016-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI3101101YP2500X
HIMHC 412101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
WI421550589OtherTRICARE HEALTH NET FEDERA
WI42230700Medicaid