Provider Demographics
NPI:1275062374
Name:LEVERIDGE, CINDI LEIGH (MA LPC)
Entity Type:Individual
Prefix:MS
First Name:CINDI
Middle Name:LEIGH
Last Name:LEVERIDGE
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:MS
Other - First Name:CINDI
Other - Middle Name:LEIGH
Other - Last Name:MADDALONE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:7 LAKEWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:WIMBERLEY
Mailing Address - State:TX
Mailing Address - Zip Code:78676-2145
Mailing Address - Country:US
Mailing Address - Phone:512-947-0672
Mailing Address - Fax:
Practice Address - Street 1:705 W HOPKINS ST
Practice Address - Street 2:
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-4379
Practice Address - Country:US
Practice Address - Phone:512-766-1736
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-06-12
Last Update Date:2017-06-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX69385101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1528464310Medicaid