Provider Demographics
NPI:1275798241
Name:CUNNINGHAM, CYNTHIA ANN (MFT)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
Last Name:CUNNINGHAM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:141 DUESENBERG DR
Mailing Address - Street 2:SUITE 5A
Mailing Address - City:WESTLAKE VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91362-3416
Mailing Address - Country:US
Mailing Address - Phone:818-575-9049
Mailing Address - Fax:805-497-1144
Practice Address - Street 1:141 DUESENBERG DR
Practice Address - Street 2:SUITE 5A
Practice Address - City:WESTLAKE VILLAGE
Practice Address - State:CA
Practice Address - Zip Code:91362-3416
Practice Address - Country:US
Practice Address - Phone:818-575-9049
Practice Address - Fax:805-497-1144
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-18
Last Update Date:2011-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA34049106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist