Provider Demographics
NPI:1780973164
Name:HEIER, CYNTHIA LEE (MFT)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:LEE
Last Name:HEIER
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:LEE
Other - Last Name:CARR
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2715 PORTER ST
Mailing Address - Street 2:SUITE 106
Mailing Address - City:SOQUEL
Mailing Address - State:CA
Mailing Address - Zip Code:95073-2458
Mailing Address - Country:US
Mailing Address - Phone:831-566-0903
Mailing Address - Fax:831-476-0258
Practice Address - Street 1:2715 PORTER ST
Practice Address - Street 2:SUITE 106
Practice Address - City:SOQUEL
Practice Address - State:CA
Practice Address - Zip Code:95073-2458
Practice Address - Country:US
Practice Address - Phone:831-566-0903
Practice Address - Fax:831-476-0258
Is Sole Proprietor?:Yes
Enumeration Date:2011-04-06
Last Update Date:2012-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC48810106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist