Provider Demographics
NPI:1407345044
Name:SMITH, CYNTHIA SUE (LPC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SUE
Last Name:SMITH
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:S
Other - Last Name:SMITH
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:7062 9 MILE RD STE C
Mailing Address - Street 2:
Mailing Address - City:MECOSTA
Mailing Address - State:MI
Mailing Address - Zip Code:49332-9376
Mailing Address - Country:US
Mailing Address - Phone:616-987-1191
Mailing Address - Fax:
Practice Address - Street 1:7062 9 MILE RD STE C
Practice Address - Street 2:
Practice Address - City:MECOSTA
Practice Address - State:MI
Practice Address - Zip Code:49332-9376
Practice Address - Country:US
Practice Address - Phone:616-987-1191
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-05-09
Last Update Date:2018-05-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015218101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health