Healthcare Provider Details

I. General information

NPI: 1831210228
Provider Name (Legal Business Name): CYNTHIA J CLINTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/03/2007
Last Update Date: 04/02/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4000 PIONEER RD STE. 105
BALCH SPRINGS TX
75180-5006
US

IV. Provider business mailing address

3824 WOOD OAK DR
BALCH SPRINGS TX
75180-2630
US

V. Phone/Fax

Practice location:
  • Phone: 214-316-0522
  • Fax:
Mailing address:
  • Phone: 972-286-6111
  • Fax: 972-286-6111

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number19656
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: