Provider Demographics
NPI:1881287241
Name:HERNANDEZ WATKINS, CYNTHIA (LCPC-9996)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:HERNANDEZ WATKINS
Suffix:
Gender:F
Credentials:LCPC-9996
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:214 E CENTER ST STE 40
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-6372
Mailing Address - Country:US
Mailing Address - Phone:208-317-8472
Mailing Address - Fax:
Practice Address - Street 1:214 E CENTER ST STE 40
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-6372
Practice Address - Country:US
Practice Address - Phone:208-232-0631
Practice Address - Fax:208-240-6215
Is Sole Proprietor?:Yes
Enumeration Date:2021-02-17
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-8287101YM0800X
251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health