Provider Demographics
NPI:1972714681
Name:CLEGG, CYNTHIA ANN (MA,,LMHC)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
Last Name:CLEGG
Suffix:
Gender:F
Credentials:MA,,LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9836 PERFECT DR
Mailing Address - Street 2:
Mailing Address - City:PORT ST LUCIE
Mailing Address - State:FL
Mailing Address - Zip Code:34986-3031
Mailing Address - Country:US
Mailing Address - Phone:772-489-4726
Mailing Address - Fax:772-489-0423
Practice Address - Street 1:2814 S US HIGHWAY 1 STE D4
Practice Address - Street 2:
Practice Address - City:FORT PIERCE
Practice Address - State:FL
Practice Address - Zip Code:34982-8110
Practice Address - Country:US
Practice Address - Phone:772-489-4726
Practice Address - Fax:772-489-0423
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH 5442101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health