Provider Demographics
NPI:1780693044
Name:SMITH, CYNTHIA M (MS, LPC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1510 S ETON ST
Mailing Address - Street 2:
Mailing Address - City:PERRYTON
Mailing Address - State:TX
Mailing Address - Zip Code:79070-4540
Mailing Address - Country:US
Mailing Address - Phone:806-434-0332
Mailing Address - Fax:806-434-2715
Practice Address - Street 1:1613 S COLGATE ST
Practice Address - Street 2:
Practice Address - City:PERRYTON
Practice Address - State:TX
Practice Address - Zip Code:79070-4815
Practice Address - Country:US
Practice Address - Phone:806-434-0332
Practice Address - Fax:806-434-2715
Is Sole Proprietor?:No
Enumeration Date:2006-08-05
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX20177101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX84922LOtherBLUE CROSS BLUE SHIELD
TXB1056244Medicare UPIN