Provider Demographics
NPI:1013468073
Name:BANDEMER, CYNTHIA (MA, MPH, LPC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:BANDEMER
Suffix:
Gender:F
Credentials:MA, MPH, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2323 CLEAR LAKE CITY BLVD STE 180-308
Mailing Address - Street 2:
Mailing Address - City:HOUSTON
Mailing Address - State:TX
Mailing Address - Zip Code:77062-8120
Mailing Address - Country:US
Mailing Address - Phone:281-787-5558
Mailing Address - Fax:
Practice Address - Street 1:17300 EL CAMINO REAL STE 107D
Practice Address - Street 2:
Practice Address - City:HOUSTON
Practice Address - State:TX
Practice Address - Zip Code:77058
Practice Address - Country:US
Practice Address - Phone:281-787-5558
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-10-14
Last Update Date:2018-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX71796101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3650327-01Medicaid