Provider Demographics
NPI:1184811366
Name:WALKLETT, CYNTHIA CAROL (LPC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:CAROL
Last Name:WALKLETT
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:WALKLETT
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LPC
Mailing Address - Street 1:3995 MARCOLA RD
Mailing Address - Street 2:3995 MARCOLA ROAD
Mailing Address - City:SPRINGFIELD
Mailing Address - State:OR
Mailing Address - Zip Code:97477-7948
Mailing Address - Country:US
Mailing Address - Phone:541-726-1465
Mailing Address - Fax:541-726-5085
Practice Address - Street 1:3995 MARCOLA RD
Practice Address - Street 2:3995 MARCOLA ROAD
Practice Address - City:SPRINGFIELD
Practice Address - State:OR
Practice Address - Zip Code:97477-7948
Practice Address - Country:US
Practice Address - Phone:541-726-1465
Practice Address - Fax:541-726-5085
Is Sole Proprietor?:No
Enumeration Date:2007-10-01
Last Update Date:2007-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC1312101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional