Provider Demographics
NPI:1457991093
Name:LUTHER, CYNTHIA GAY (LSPE/HSP)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:GAY
Last Name:LUTHER
Suffix:
Gender:F
Credentials:LSPE/HSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:702 WEAKLEY LN
Mailing Address - Street 2:
Mailing Address - City:SMYRNA
Mailing Address - State:TN
Mailing Address - Zip Code:37167-4805
Mailing Address - Country:US
Mailing Address - Phone:615-516-1823
Mailing Address - Fax:
Practice Address - Street 1:702 WEAKLEY LN
Practice Address - Street 2:
Practice Address - City:SMYRNA
Practice Address - State:TN
Practice Address - Zip Code:37167-4805
Practice Address - Country:US
Practice Address - Phone:615-516-1823
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-01-12
Last Update Date:2020-01-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PE103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling