Provider Demographics
NPI:1912562968
Name:LANGE, CYNTHIA L (LPC)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:L
Last Name:LANGE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:LANGE
Other - Last Name:NAFTZGER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:129 FAIRWAY CIRCLE
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83201-2051
Mailing Address - Country:US
Mailing Address - Phone:406-848-4827
Mailing Address - Fax:833-899-5112
Practice Address - Street 1:330 S 4TH AVE
Practice Address - Street 2:
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201
Practice Address - Country:US
Practice Address - Phone:406-848-4827
Practice Address - Fax:833-899-5112
Is Sole Proprietor?:Yes
Enumeration Date:2019-05-06
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLPC-6934101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional