Provider Demographics
NPI:1942449814
Name:LOSE, CYNTHIA AGNES (PSYD)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:AGNES
Last Name:LOSE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:215 W BROADWAY ST
Mailing Address - Street 2:SUITE #1
Mailing Address - City:HOBBS
Mailing Address - State:NM
Mailing Address - Zip Code:88240-6065
Mailing Address - Country:US
Mailing Address - Phone:575-393-0692
Mailing Address - Fax:575-393-0796
Practice Address - Street 1:215 W BROADWAY ST
Practice Address - Street 2:SUITE #1
Practice Address - City:HOBBS
Practice Address - State:NM
Practice Address - Zip Code:88240-6065
Practice Address - Country:US
Practice Address - Phone:575-393-0692
Practice Address - Fax:575-393-0796
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0801103TC0700X
CA02164103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical