Healthcare Provider Details

I. General information

NPI: 1427396126
Provider Name (Legal Business Name): CYNTHIA MAE HOVIS LCSW
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/30/2013
Last Update Date: 01/30/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

605 OLD BALLAS RD SUITE 123
SAINT LOUIS MO
63141-7000
US

IV. Provider business mailing address

605 OLD BALLAS RD SUITE 123
SAINT LOUIS MO
63141-7000
US

V. Phone/Fax

Practice location:
  • Phone: 888-505-6444
  • Fax: 314-729-4002
Mailing address:
  • Phone: 888-505-6444
  • Fax: 314-729-4002

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number2011029604
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: