Provider Demographics
NPI:1790076719
Name:PARENT, CYNTHIA LORRAINE (BS)
Entity Type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:LORRAINE
Last Name:PARENT
Suffix:
Gender:F
Credentials:BS
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 354
Mailing Address - Street 2:
Mailing Address - City:LOCUST GROVE
Mailing Address - State:OK
Mailing Address - Zip Code:74352-0354
Mailing Address - Country:US
Mailing Address - Phone:956-336-5373
Mailing Address - Fax:
Practice Address - Street 1:1339 N. 435 RD.
Practice Address - Street 2:
Practice Address - City:LOCUST GROVE
Practice Address - State:OK
Practice Address - Zip Code:74352-0354
Practice Address - Country:US
Practice Address - Phone:956-336-5373
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-25
Last Update Date:2016-01-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK000101YM0800X
OK251SOOOOOX251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK000OtherPRSS