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General NPI Number Information
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NPI Number | 1356565535
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Entity Type | Individual
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Provider Name | CYNTHIA DIANE STUDEBAKER LPC
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Gender | Female
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Dates
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Enumeration Date | 04/12/2007
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Last Update Date | 09/18/2024
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Provider Practice Location Address
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Address Line | 26 COYOTE LOOP
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City | ARROYO HONDO
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State | NM
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Zip | 87513-8016
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Country | US
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Telephone | 303-913-4892
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 1074
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City | EL PRADO
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State | NM
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Zip | 87529-1074
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Country | US
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Telephone | 303-913-4892
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 3122
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License Number State | CO
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | CCMH0211951
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License Number State | NM
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