Provider Demographics
NPI:1669611927
Name:HALLIDAY, CYNTHIA (LMFT)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:
Last Name:HALLIDAY
Suffix:
Gender:F
Credentials:LMFT
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 261
Mailing Address - Street 2:
Mailing Address - City:FULTON
Mailing Address - State:CA
Mailing Address - Zip Code:95439-0261
Mailing Address - Country:US
Mailing Address - Phone:707-544-1513
Mailing Address - Fax:707-544-1513
Practice Address - Street 1:3442 MENDOCINO AVE
Practice Address - Street 2:SUITE A, BLDG. E
Practice Address - City:SANTA ROSA
Practice Address - State:CA
Practice Address - Zip Code:95403-2221
Practice Address - Country:US
Practice Address - Phone:707-544-1513
Practice Address - Fax:707-544-1513
Is Sole Proprietor?:Yes
Enumeration Date:2009-02-10
Last Update Date:2014-07-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA45120106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist