Healthcare Provider Details

I. General information

NPI: 1578278610
Provider Name (Legal Business Name): CYNTHIA GUMP LPC-ASSOCIATE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/23/2023
Last Update Date: 01/23/2023
Certification Date: 01/22/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8350 N CENTRAL EXPY STE 1275
DALLAS TX
75206-1614
US

IV. Provider business mailing address

1512 PORSCHE CT
PLANO TX
75023-1900
US

V. Phone/Fax

Practice location:
  • Phone: 940-268-4184
  • Fax:
Mailing address:
  • Phone: 812-584-7513
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number90115
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: