Provider Demographics
NPI:1427234269
Name:HENRIE, CYNTHIA A (MFT, BCETS)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:A
Last Name:HENRIE
Suffix:
Gender:
Credentials:MFT, BCETS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2107 PANAMINT DR
Mailing Address - Street 2:
Mailing Address - City:LOS ANGELES
Mailing Address - State:CA
Mailing Address - Zip Code:90065-3433
Mailing Address - Country:US
Mailing Address - Phone:323-829-3548
Mailing Address - Fax:
Practice Address - Street 1:2107 PANAMINT DR
Practice Address - Street 2:
Practice Address - City:LOS ANGELES
Practice Address - State:CA
Practice Address - Zip Code:90065-3433
Practice Address - Country:US
Practice Address - Phone:323-829-3548
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-01-10
Last Update Date:2025-03-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA41617106H00000X
CAMFC 41617106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA11784126OtherCAQH PROVIDER ID