Healthcare Provider Details

I. General information

NPI: 1174798375
Provider Name (Legal Business Name): CYNTHIA M HARTUNG PH.D.
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/28/2008
Last Update Date: 04/28/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

507 S 4TH ST SUITE A
LARAMIE WY
82070-3753
US

IV. Provider business mailing address

507 S 4TH ST SUITE A
LARAMIE WY
82070-3753
US

V. Phone/Fax

Practice location:
  • Phone: 307-460-0119
  • Fax: 307-742-4089
Mailing address:
  • Phone: 307-460-0119
  • Fax: 307-742-4089

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number457
License Number StateWY
# 2
Primary TaxonomyY
Taxonomy Code103TC2200X
TaxonomyClinical Child & Adolescent Psychologist
License Number457
License Number StateWY
# 3
Primary TaxonomyN
Taxonomy Code103TM1800X
TaxonomyIntellectual & Developmental Disabilities Psychologist
License Number457
License Number StateWY

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: