Healthcare Provider Details

I. General information

NPI: 1912582420
Provider Name (Legal Business Name): CYNTHIA TERESA SAX BS, R-AAC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/16/2021
Last Update Date: 10/24/2024
Certification Date: 10/24/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1131 BROADWAY ST
LONGVIEW WA
98632-3830
US

IV. Provider business mailing address

PO BOX 2394
LONGVIEW WA
98632-8455
US

V. Phone/Fax

Practice location:
  • Phone: 360-998-3050
  • Fax: 360-200-6736
Mailing address:
  • Phone: 360-200-5419
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberCG61159901
License Number StateWA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: