Provider Demographics
NPI:1457779001
Name:CYNTHIA J CLINTON, LPC
Entity Type:Organization
Organization Name:CYNTHIA J CLINTON, LPC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:CYNTHIA
Authorized Official - Middle Name:J
Authorized Official - Last Name:CLINTON
Authorized Official - Suffix:
Authorized Official - Credentials:LPC
Authorized Official - Phone:214-316-0522
Mailing Address - Street 1:3824 WOOD OAK DR
Mailing Address - Street 2:
Mailing Address - City:BALCH SPRINGS
Mailing Address - State:TX
Mailing Address - Zip Code:75180-2630
Mailing Address - Country:US
Mailing Address - Phone:214-316-0522
Mailing Address - Fax:972-286-6111
Practice Address - Street 1:4000 PIONEER RD
Practice Address - Street 2:STE. 105
Practice Address - City:BALCH SPRINGS
Practice Address - State:TX
Practice Address - Zip Code:75180-5006
Practice Address - Country:US
Practice Address - Phone:214-316-0522
Practice Address - Fax:972-286-6111
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-01
Last Update Date:2014-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX19656251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3238057Medicaid