Provider Demographics
NPI:1831809334
Name:MCCALL, CYNTHIA LYN
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYN
Last Name:MCCALL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7166 CR 154
Mailing Address - Street 2:
Mailing Address - City:SALIDA
Mailing Address - State:CO
Mailing Address - Zip Code:81201
Mailing Address - Country:US
Mailing Address - Phone:719-276-5488
Mailing Address - Fax:719-626-1268
Practice Address - Street 1:7166 CR 154
Practice Address - Street 2:
Practice Address - City:SALIDA
Practice Address - State:CO
Practice Address - Zip Code:81201
Practice Address - Country:US
Practice Address - Phone:719-276-5488
Practice Address - Fax:719-626-1268
Is Sole Proprietor?:No
Enumeration Date:2022-11-25
Last Update Date:2022-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2143101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)