Provider Demographics
NPI:1558025403
Name:CROUCH, CYNTHIA (LMHC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:CROUCH
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:40897 W 5TH AVE
Mailing Address - Street 2:
Mailing Address - City:UMATILLA
Mailing Address - State:FL
Mailing Address - Zip Code:32784-9386
Mailing Address - Country:US
Mailing Address - Phone:407-963-0152
Mailing Address - Fax:
Practice Address - Street 1:40897 W 5TH AVE
Practice Address - Street 2:
Practice Address - City:UMATILLA
Practice Address - State:FL
Practice Address - Zip Code:32784-9386
Practice Address - Country:US
Practice Address - Phone:407-963-0152
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-10-27
Last Update Date:2021-10-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH18812101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health