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NPI Code Detail

MEDICARE: MS. CYNTHIA ANN CLEGG MA,,LMHC

MEDICARE: MS. CYNTHIA ANN CLEGG MA,,LMHC
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
1101YM0800XMental Health CounselorMH 5442FL

General Provider Information

NPI Number : 1972714681
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CYNTHIA ANN CLEGG MA,,LMHC
Provider Business Mailing Address
First Line : 9836 PERFECT DR
Second Line :
City : PORT ST LUCIE
State : FL
Zip : 34986-3031
Country : US
Telephone Number : 772-489-4726
Fax Number : 772-489-0423
Provider Business Practice Location Address
First Line : 2814 S US HIGHWAY 1 STE D4
Second Line :
City : FORT PIERCE
State : FL
Zip : 34982-8110
Country : US
Telephone Number : 772-489-4726
Fax Number : 772-489-0423
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 05/24/2007
Last Update Date : 07/08/2007

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