Provider Demographics
NPI:1316211691
Name:FULREADER, CYNTHIA (LPC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:FULREADER
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2844 VEREDA DE PUEBLO
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87507-5386
Mailing Address - Country:US
Mailing Address - Phone:505-473-4420
Mailing Address - Fax:
Practice Address - Street 1:1919 5TH ST
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-5402
Practice Address - Country:US
Practice Address - Phone:505-795-8831
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-03-03
Last Update Date:2012-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM1808101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health