Provider Demographics
NPI:1952624942
Name:MACK-ERNSDORFF, CYNTHIA S (LMHC,LMFT,CDP,HP)
Entity Type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:S
Last Name:MACK-ERNSDORFF
Suffix:
Gender:F
Credentials:LMHC,LMFT,CDP,HP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1827 218TH PL NE
Mailing Address - Street 2:
Mailing Address - City:SAMMAMISH
Mailing Address - State:WA
Mailing Address - Zip Code:98074-4112
Mailing Address - Country:US
Mailing Address - Phone:425-788-1710
Mailing Address - Fax:
Practice Address - Street 1:1827 218TH PL NE
Practice Address - Street 2:
Practice Address - City:SAMMAMISH
Practice Address - State:WA
Practice Address - Zip Code:98074-4112
Practice Address - Country:US
Practice Address - Phone:425-788-1710
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-03-05
Last Update Date:2010-03-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP00006138101YA0400X
WALH00009947101YM0800X
WALF00002676106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
WACP00006138OtherCHEMICAL DEPENDENCY PROFESSIONAL
WALF00002676OtherMARRIAGE AND FAMILY THERAPY
WAHP10000966OtherCLINICAL HYPNOTHERAPY
WALH00009947OtherMENTAL HEALTH