Provider Demographics
NPI:1245249747
Name:DEVLIN, CYNTHIA BERGSTROM (LPCC, LMFT)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:BERGSTROM
Last Name:DEVLIN
Suffix:
Gender:F
Credentials:LPCC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6 BUENA VENTURA PL
Mailing Address - Street 2:
Mailing Address - City:SANTA FE
Mailing Address - State:NM
Mailing Address - Zip Code:87508-8377
Mailing Address - Country:US
Mailing Address - Phone:505-303-3586
Mailing Address - Fax:505-303-3586
Practice Address - Street 1:1229 S SAINT FRANCIS DR STE B
Practice Address - Street 2:
Practice Address - City:SANTA FE
Practice Address - State:NM
Practice Address - Zip Code:87505-4052
Practice Address - Country:US
Practice Address - Phone:505-303-3586
Practice Address - Fax:505-303-3586
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-05
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NM0189951101YM0800X, 101YP2500X
NM0189901106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Single Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA223065OtherANTHEM BC/BS