Provider Demographics
NPI:1396882049
Name:JOHNSON, CYNTHIA MARION (LPC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:MARION
Last Name:JOHNSON
Suffix:
Gender:F
Credentials:LPC
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 202
Mailing Address - Street 2:
Mailing Address - City:ALLENSPARK
Mailing Address - State:CO
Mailing Address - Zip Code:80510-0202
Mailing Address - Country:US
Mailing Address - Phone:303-747-2312
Mailing Address - Fax:
Practice Address - Street 1:880 MACGREGOR AVENUE
Practice Address - Street 2:
Practice Address - City:ESTES PARK
Practice Address - State:CO
Practice Address - Zip Code:80517
Practice Address - Country:US
Practice Address - Phone:303-747-2312
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-31
Last Update Date:2020-02-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
COLPC.0011450101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
1396882049OtherI HAVE PEOPLE PAY CASH AND DON'T NEED THIS NUMBER