Provider Demographics
NPI:1518389477
Name:ST CYR, ADAM VICTOR (LPC)
Entity type:Individual
Prefix:MR
First Name:ADAM
Middle Name:VICTOR
Last Name:ST CYR
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2417 BUTTON WILLOW PKWY
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79606-3509
Mailing Address - Country:US
Mailing Address - Phone:325-669-0197
Mailing Address - Fax:
Practice Address - Street 1:1219 E SOUTH 11TH ST
Practice Address - Street 2:STE A
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79602-4283
Practice Address - Country:US
Practice Address - Phone:325-669-0197
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-01-13
Last Update Date:2014-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX67315101YP2500X
1-12-12180103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst