Provider Demographics
NPI:1194869560
Name:SMITH, CYNTHIA M (MS, MFT)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:M
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7350 EL CAMINO REAL
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ATASCADERO
Mailing Address - State:CA
Mailing Address - Zip Code:93422-4655
Mailing Address - Country:US
Mailing Address - Phone:805-462-1503
Mailing Address - Fax:
Practice Address - Street 1:7350 EL CAMINO REAL
Practice Address - Street 2:SUITE 104
Practice Address - City:ATASCADERO
Practice Address - State:CA
Practice Address - Zip Code:93422-4655
Practice Address - Country:US
Practice Address - Phone:805-462-1503
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC18170106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist