Provider Demographics
NPI:1457308819
Name:WINTERS, CYNTHIA (LCPC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:WINTERS
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:202 CONWAY DR
Mailing Address - Street 2:SUITE 100
Mailing Address - City:KALISPELL
Mailing Address - State:MT
Mailing Address - Zip Code:59901-3112
Mailing Address - Country:US
Mailing Address - Phone:406-751-5664
Mailing Address - Fax:406-755-0971
Practice Address - Street 1:7325 US HIGHWAY 93
Practice Address - Street 2:SUITE A
Practice Address - City:LAKESIDE
Practice Address - State:MT
Practice Address - Zip Code:59922-9704
Practice Address - Country:US
Practice Address - Phone:406-844-2890
Practice Address - Fax:406-844-2891
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-05-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT1084 LCPC101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT256105Medicaid
MT741210OtherBLUE CROSS