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General NPI Number Information
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NPI Number | 1053964866
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Entity Type | Organization
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Legal Business Name | CYNTHIA PROBST LMHC LLC
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Dates
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Enumeration Date | 07/20/2019
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Last Update Date | 07/20/2019
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Provider Practice Location Address
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Address Line | 1025 W RUDISILL BLVD STE 202
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City | FORT WAYNE
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State | IN
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Zip | 46807-2168
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Country | US
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Telephone | 260-423-0032
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Fax |
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Provider Business Mailing Address
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Address Line | 4302 S WAYNE AVE
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City | FORT WAYNE
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State | IN
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Zip | 46807-2645
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Country | US
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Telephone | 260-241-5867
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Fax |
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Authorized Official
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Title or Position | OWNER
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Name | MS. CYNTHIA D PROBST
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Credential | LMHC
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Telephone | 260-241-5867
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0801X
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Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
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License Number |
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License Number State |
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