Provider Demographics
NPI:1518011071
Name:MOUNT, CYNTHIA SQUIRE (OMD, NMD)
Entity Type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:SQUIRE
Last Name:MOUNT
Suffix:
Gender:F
Credentials:OMD, NMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:114 N BOULEVARD ST
Mailing Address - Street 2:SUITE 108
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230-3000
Mailing Address - Country:US
Mailing Address - Phone:970-641-1200
Mailing Address - Fax:
Practice Address - Street 1:114 N BOULEVARD ST
Practice Address - Street 2:SUITE 108
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230-3000
Practice Address - Country:US
Practice Address - Phone:970-641-1200
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-22
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO010898171100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes171100000XOther Service ProvidersAcupuncturist