Provider Demographics
NPI:1013170158
Name:MCCONNELL, CYNTHIA MICHELLE (MS)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MICHELLE
Last Name:MCCONNELL
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2932 NW 122ND ST
Mailing Address - Street 2:SUITE 20
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73120-1957
Mailing Address - Country:US
Mailing Address - Phone:405-315-1447
Mailing Address - Fax:405-242-5345
Practice Address - Street 1:2932 NW 122ND ST
Practice Address - Street 2:SUITE 20
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73120-1957
Practice Address - Country:US
Practice Address - Phone:405-315-1447
Practice Address - Fax:405-242-5345
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-09
Last Update Date:2010-08-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK977106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK100728800CMedicaid