Provider Demographics
NPI:1750813424
Name:PETTUS, CYNTHIA L (MED, PLPC, NCC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:PETTUS
Suffix:
Gender:F
Credentials:MED, PLPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3439 MAGAZINE ST
Mailing Address - Street 2:
Mailing Address - City:NEW ORLEANS
Mailing Address - State:LA
Mailing Address - Zip Code:70115-2446
Mailing Address - Country:US
Mailing Address - Phone:504-891-8808
Mailing Address - Fax:504-891-8883
Practice Address - Street 1:3439 MAGAZINE ST
Practice Address - Street 2:
Practice Address - City:NEW ORLEANS
Practice Address - State:LA
Practice Address - Zip Code:70115-2446
Practice Address - Country:US
Practice Address - Phone:504-891-8808
Practice Address - Fax:504-891-8883
Is Sole Proprietor?:No
Enumeration Date:2017-03-31
Last Update Date:2017-03-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAPLC6949101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional