Provider Demographics
NPI:1821129180
Name:HIMSTEDT, CYNTHIA MARGARET
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARGARET
Last Name:HIMSTEDT
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2483 MILLVALLEY DR
Mailing Address - Street 2:
Mailing Address - City:FLORISSANT
Mailing Address - State:MO
Mailing Address - Zip Code:63031-2856
Mailing Address - Country:US
Mailing Address - Phone:314-972-7614
Mailing Address - Fax:
Practice Address - Street 1:2483 MILLVALLEY DR
Practice Address - Street 2:
Practice Address - City:FLORISSANT
Practice Address - State:MO
Practice Address - Zip Code:63031-2856
Practice Address - Country:US
Practice Address - Phone:314-972-7614
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20030187331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical