Provider Demographics
NPI:1689080285
Name:ANDERSON, CYNTHIA ANN (MED, LPC, CSC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:ANN
Last Name:ANDERSON
Suffix:
Gender:F
Credentials:MED, LPC, CSC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 3245
Mailing Address - Street 2:NONE
Mailing Address - City:BANDERA
Mailing Address - State:TX
Mailing Address - Zip Code:78003-3245
Mailing Address - Country:US
Mailing Address - Phone:830-796-8488
Mailing Address - Fax:
Practice Address - Street 1:503 NINTH ST.
Practice Address - Street 2:NONE
Practice Address - City:BANDERA
Practice Address - State:TX
Practice Address - Zip Code:78003
Practice Address - Country:US
Practice Address - Phone:830-796-8488
Practice Address - Fax:830-796-8488
Is Sole Proprietor?:Yes
Enumeration Date:2014-07-03
Last Update Date:2014-07-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14989101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX101Y00000XMedicaid