MEDICARE: CYNTHIA A. CHAMPION LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	L295	AL

General Provider Information

NPI Number	:	1457402117
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA A. CHAMPION LMFT

Provider Business Mailing Address
First Line	:	386 SAINT LUKES DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7108
Country	:	US
Telephone Number	:	334-244-0702
Fax Number	:	334-277-2786

Provider Business Practice Location Address
First Line	:	386 SAINT LUKES DR
Second Line	:
City	:	MONTGOMERY
State	:	AL
Zip	:	36117-7108
Country	:	US
Telephone Number	:	334-244-0702
Fax Number	:	334-277-2786

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	01/16/2007
Last Update Date	:	07/21/2022

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