Provider Demographics
NPI:1699155572
Name:DERVAES, CYNTHIA (LPC)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:
Last Name:DERVAES
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MS
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:BARLOW
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:301 W WASHINGTON AVE
Mailing Address - Street 2:
Mailing Address - City:MCALESTER
Mailing Address - State:OK
Mailing Address - Zip Code:74501-4448
Mailing Address - Country:US
Mailing Address - Phone:719-440-8607
Mailing Address - Fax:
Practice Address - Street 1:301 W WASHINGTON AVE
Practice Address - Street 2:
Practice Address - City:MCALESTER
Practice Address - State:OK
Practice Address - Zip Code:74501-4448
Practice Address - Country:US
Practice Address - Phone:719-440-8607
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-06-04
Last Update Date:2015-06-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK5717101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional