Provider Demographics
NPI:1518090208
Name:NIEDBALSKI, CYNTHIA A (LPC)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:A
Last Name:NIEDBALSKI
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MISS
Other - First Name:CYNTHIA
Other - Middle Name:ANN
Other - Last Name:SIFFORD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:38 FOX HOLLOW DR
Mailing Address - Street 2:
Mailing Address - City:SAINT CHARLES
Mailing Address - State:MO
Mailing Address - Zip Code:63304-7626
Mailing Address - Country:US
Mailing Address - Phone:636-240-0523
Mailing Address - Fax:636-240-0261
Practice Address - Street 1:214 CHURCH ST
Practice Address - Street 2:
Practice Address - City:O FALLON
Practice Address - State:MO
Practice Address - Zip Code:63366-2814
Practice Address - Country:US
Practice Address - Phone:314-706-9493
Practice Address - Fax:636-240-0261
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-13
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2000150932101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO372818OtherMENTAL HEALTH NETWORK
MO173405OtherANTHEM BLUE CROSS
MO11567580OtherCAQH
MO479705OtherVALUE OPTIONS