Provider Demographics
NPI:1801801618
Name:BEANBLOSSOM, CYNTHIA L (MED, LPC)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:L
Last Name:BEANBLOSSOM
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:42909 N RALEIGH CT
Mailing Address - Street 2:
Mailing Address - City:ANTHEM
Mailing Address - State:AZ
Mailing Address - Zip Code:85086-8007
Mailing Address - Country:US
Mailing Address - Phone:489-650-9260
Mailing Address - Fax:623-551-3453
Practice Address - Street 1:42909 N RALEIGH CT
Practice Address - Street 2:
Practice Address - City:ANTHEM
Practice Address - State:AZ
Practice Address - Zip Code:85086-8007
Practice Address - Country:US
Practice Address - Phone:489-650-9260
Practice Address - Fax:623-551-3453
Is Sole Proprietor?:Yes
Enumeration Date:2006-07-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC #10423101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional