Provider Demographics
NPI:1487745030
Name:FRITZ, CYNTHIA (LPC, LCSW)
Entity type:Individual
Prefix:MS
First Name:CYNTHIA
Middle Name:
Last Name:FRITZ
Suffix:
Gender:F
Credentials:LPC, LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:12147 NATURAL BRIDGE RD.
Mailing Address - Street 2:
Mailing Address - City:BRIDGETON
Mailing Address - State:MO
Mailing Address - Zip Code:63044
Mailing Address - Country:US
Mailing Address - Phone:314-298-0602
Mailing Address - Fax:314-895-4641
Practice Address - Street 1:12147 NATURAL BRIDGE RD.
Practice Address - Street 2:
Practice Address - City:BRIDGETON
Practice Address - State:MO
Practice Address - Zip Code:63044
Practice Address - Country:US
Practice Address - Phone:314-298-0602
Practice Address - Fax:314-895-4641
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO001104101YM0800X
MO0041581041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO431718980FRIOtherUMMH
MO493453179Medicaid
MO176522OtherBLUE CROSS BLUE SHIELD