Healthcare Provider Details

I. General information

NPI: 1417405523
Provider Name (Legal Business Name): CYNTHIA CARRELL LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: CYNTHIA HAUSER LCSW

II. Dates (important events)

Enumeration Date: 09/17/2016
Last Update Date: 11/30/2025
Certification Date: 11/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

301 E BETHANY HOME RD STE C189
PHOENIX AZ
85012-1295
US

IV. Provider business mailing address

301 E BETHANY HOME RD STE C189
PHOENIX AZ
85012-1295
US

V. Phone/Fax

Practice location:
  • Phone: 480-313-0020
  • Fax:
Mailing address:
  • Phone: 480-313-0020
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15570
License Number StateAZ

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: