Provider Demographics
NPI:1376784546
Name:SMOCK, CYNTHIA COOPER (MA, LPC, CAC III)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:COOPER
Last Name:SMOCK
Suffix:
Gender:F
Credentials:MA, LPC, CAC III
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 801
Mailing Address - Street 2:
Mailing Address - City:GUNNISON
Mailing Address - State:CO
Mailing Address - Zip Code:81230
Mailing Address - Country:US
Mailing Address - Phone:970-641-5119
Mailing Address - Fax:970-641-5118
Practice Address - Street 1:107 E GEORGIA
Practice Address - Street 2:SUITE 3E
Practice Address - City:GUNNISON
Practice Address - State:CO
Practice Address - Zip Code:81230
Practice Address - Country:US
Practice Address - Phone:970-641-5119
Practice Address - Fax:970-641-5118
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2606101YA0400X
CO284101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)