Provider Demographics
NPI:1962965111
Name:PALEN, CINDY (LAC, NCC)
Entity type:Individual
Prefix:
First Name:CINDY
Middle Name:
Last Name:PALEN
Suffix:
Gender:F
Credentials:LAC, NCC
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:
Other - Last Name:PALEN
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:LAC, NCC
Mailing Address - Street 1:4017 ENGLEFIELD
Mailing Address - Street 2:
Mailing Address - City:BENTONVILLE
Mailing Address - State:AR
Mailing Address - Zip Code:72713-7937
Mailing Address - Country:US
Mailing Address - Phone:314-225-6355
Mailing Address - Fax:
Practice Address - Street 1:6815 ISAACS ORCHARD RD STE B1
Practice Address - Street 2:
Practice Address - City:SPRINGDALE
Practice Address - State:AR
Practice Address - Zip Code:72762-6902
Practice Address - Country:US
Practice Address - Phone:479-222-1711
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2019-04-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ARA1903034101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health