Healthcare Provider Details

I. General information

NPI: 1700104635
Provider Name (Legal Business Name): CYNTHIA D HOLCOMB LSCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/17/2010
Last Update Date: 10/04/2023
Certification Date: 10/04/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

411 N OSAGE RD
DERBY KS
67037-2084
US

IV. Provider business mailing address

411 N OSAGE RD
DERBY KS
67037-2084
US

V. Phone/Fax

Practice location:
  • Phone: 316-788-1907
  • Fax:
Mailing address:
  • Phone: 316-788-1907
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code104100000X
TaxonomySocial Worker
License Number4695
License Number StateKS
# 2
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number5238
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: