Provider Demographics
NPI:1962572842
Name:GREGORY, CYNTHIA K
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:K
Last Name:GREGORY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:CINDY
Other - Middle Name:
Other - Last Name:GREGORY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 671
Mailing Address - Street 2:
Mailing Address - City:ROSLYN
Mailing Address - State:WA
Mailing Address - Zip Code:98941-0671
Mailing Address - Country:US
Mailing Address - Phone:509-674-5144
Mailing Address - Fax:
Practice Address - Street 1:112 W RAILROAD ST
Practice Address - Street 2:SUITE 201
Practice Address - City:CLE ELUM
Practice Address - State:WA
Practice Address - Zip Code:98922-1131
Practice Address - Country:US
Practice Address - Phone:509-674-5144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-08
Last Update Date:2012-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACL60128147101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health