Provider Demographics
NPI:1851679344
Name:ERVIN, CYNTHIA MIA
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MIA
Last Name:ERVIN
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 1:1636 SAWTOOTH TRL
Mailing Address - Street 2:
Mailing Address - City:RENO
Mailing Address - State:NV
Mailing Address - Zip Code:89523-6818
Mailing Address - Country:US
Mailing Address - Phone:775-747-8919
Mailing Address - Fax:
Practice Address - Street 1:2370 RIDGE FIELD TRL
Practice Address - Street 2:
Practice Address - City:RENO
Practice Address - State:NV
Practice Address - Zip Code:89523-6803
Practice Address - Country:US
Practice Address - Phone:775-384-3587
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2011-08-01
Last Update Date:2011-08-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst