Provider Demographics
NPI:1427306992
Name:LEBLANC, CYNTHIA ANN (MFT)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:ANN
Last Name:LEBLANC
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:LEBLANC
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LMFT
Mailing Address - Street 1:1765 RIMWOOD DR
Mailing Address - Street 2:
Mailing Address - City:COLORADO SPRINGS
Mailing Address - State:CO
Mailing Address - Zip Code:80918-7874
Mailing Address - Country:US
Mailing Address - Phone:719-331-6653
Mailing Address - Fax:
Practice Address - Street 1:2500 N CIRCLE DR STE 400
Practice Address - Street 2:
Practice Address - City:COLORADO SPRINGS
Practice Address - State:CO
Practice Address - Zip Code:80909-1184
Practice Address - Country:US
Practice Address - Phone:719-331-6653
Practice Address - Fax:719-623-0458
Is Sole Proprietor?:No
Enumeration Date:2012-08-15
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0001198106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO9000148438Medicaid