Provider Demographics
NPI:1952836488
Name:SCOVEL, CYNTHIA SUSANNE (LLPC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:SUSANNE
Last Name:SCOVEL
Suffix:
Gender:F
Credentials:LLPC
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:SCOVEL
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:5104 LOVERS LN
Mailing Address - Street 2:
Mailing Address - City:PORTAGE
Mailing Address - State:MI
Mailing Address - Zip Code:49002-1558
Mailing Address - Country:US
Mailing Address - Phone:512-417-3261
Mailing Address - Fax:
Practice Address - Street 1:5104 LOVERS LN
Practice Address - Street 2:
Practice Address - City:PORTAGE
Practice Address - State:MI
Practice Address - Zip Code:49002-1558
Practice Address - Country:US
Practice Address - Phone:512-417-3261
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-04-21
Last Update Date:2017-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401015999101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional