Provider Demographics
NPI:1083828073
Name:MACDONALD, CYNTHIA (MA, LPC, CAC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:
Last Name:MACDONALD
Suffix:
Gender:F
Credentials:MA, LPC, CAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:655 E VALLEY RD
Mailing Address - Street 2:SUITE# 200A
Mailing Address - City:BASALT
Mailing Address - State:CO
Mailing Address - Zip Code:81621-8317
Mailing Address - Country:US
Mailing Address - Phone:970-963-5661
Mailing Address - Fax:970-963-5841
Practice Address - Street 1:655 E VALLEY RD
Practice Address - Street 2:SUITE# 200A
Practice Address - City:BASALT
Practice Address - State:CO
Practice Address - Zip Code:81621-8317
Practice Address - Country:US
Practice Address - Phone:970-963-5661
Practice Address - Fax:970-963-5841
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO2429101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health