Provider Demographics
NPI:1912417395
Name:BUETOW, CYNTHIA LYNN (APPC)
Entity Type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LYNN
Last Name:BUETOW
Suffix:
Gender:F
Credentials:APPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5050 GRAINFLAT RD
Mailing Address - Street 2:
Mailing Address - City:PLYMOUTH
Mailing Address - State:CA
Mailing Address - Zip Code:95669-9766
Mailing Address - Country:US
Mailing Address - Phone:707-483-9842
Mailing Address - Fax:
Practice Address - Street 1:564 MOUNTAIN RANCH RD STE 5
Practice Address - Street 2:
Practice Address - City:SAN ANDREAS
Practice Address - State:CA
Practice Address - Zip Code:95249-9782
Practice Address - Country:US
Practice Address - Phone:530-626-3105
Practice Address - Fax:209-498-2042
Is Sole Proprietor?:No
Enumeration Date:2017-10-11
Last Update Date:2021-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA4004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional