Provider Demographics
NPI:1740441724
Name:ANDERTON, CINDY L (MCOUN, LCPC)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:L
Last Name:ANDERTON
Suffix:
Gender:F
Credentials:MCOUN, LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10050 W BELOIT RD APT 21
Mailing Address - Street 2:
Mailing Address - City:GREENFIELD
Mailing Address - State:WI
Mailing Address - Zip Code:53228-1253
Mailing Address - Country:US
Mailing Address - Phone:618-559-4751
Mailing Address - Fax:
Practice Address - Street 1:10050 W BELOIT RD APT 21
Practice Address - Street 2:
Practice Address - City:GREENFIELD
Practice Address - State:WI
Practice Address - Zip Code:53228-1253
Practice Address - Country:US
Practice Address - Phone:618-559-4751
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-06-22
Last Update Date:2008-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WI4086-125101YM0800X
IL180.006288101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health