Provider Demographics
NPI:1245403658
Name:NASSAR, CYNTHIA (LPC, LMFT)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:NASSAR
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 6446
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70606-6446
Mailing Address - Country:US
Mailing Address - Phone:337-540-4205
Mailing Address - Fax:337-474-8123
Practice Address - Street 1:4216 LAKE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-4308
Practice Address - Country:US
Practice Address - Phone:337-540-4205
Practice Address - Fax:337-474-8123
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-07
Last Update Date:2014-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2140101YP2500X
LA574106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional