Provider Demographics
NPI:1699945246
Name:PRATHER, CYNTHIA LORRAYNE LANE (MSED)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:LORRAYNE LANE
Last Name:PRATHER
Suffix:
Gender:F
Credentials:MSED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1201 ARBOR DR.
Mailing Address - Street 2:
Mailing Address - City:SOUTH SIOUX CITY
Mailing Address - State:NE
Mailing Address - Zip Code:68776-2652
Mailing Address - Country:US
Mailing Address - Phone:402-494-3337
Mailing Address - Fax:402-494-3356
Practice Address - Street 1:3320 W 4TH ST
Practice Address - Street 2:
Practice Address - City:SIOUX CITY
Practice Address - State:IA
Practice Address - Zip Code:51103-3200
Practice Address - Country:US
Practice Address - Phone:712-202-0777
Practice Address - Fax:712-202-0780
Is Sole Proprietor?:No
Enumeration Date:2008-03-10
Last Update Date:2023-03-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5572101YM0800X
IA001346101YM0800X
NE2533101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health