Provider Demographics
NPI:1609551845
Name:HENRY, CYNTHIA DIANE (EDS, MED)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:DIANE
Last Name:HENRY
Suffix:
Gender:F
Credentials:EDS, MED
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:DIANE
Other - Last Name:BECKWITH/MCAFEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:SAME
Mailing Address - Street 1:11664 NE AVERY ST
Mailing Address - Street 2:
Mailing Address - City:NEWPORT
Mailing Address - State:OR
Mailing Address - Zip Code:97365-9545
Mailing Address - Country:US
Mailing Address - Phone:541-961-7556
Mailing Address - Fax:
Practice Address - Street 1:11664 NE AVERY ST
Practice Address - Street 2:
Practice Address - City:NEWPORT
Practice Address - State:OR
Practice Address - Zip Code:97365-9545
Practice Address - Country:US
Practice Address - Phone:541-961-7556
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-06-15
Last Update Date:2023-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR10409234101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor