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General NPI Number Information
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NPI Number | 1366597981
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Entity Type | Individual
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Provider Name | CYNTHIA ANN EWERS PH.D.
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Gender | Female
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Dates
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Enumeration Date | 01/24/2007
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Last Update Date | 07/09/2007
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Provider Practice Location Address
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Address Line | 1 MILE N 522 QUESTA
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City | QUESTA
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State | NM
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Zip | 87556-0440
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Country | US
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Telephone | 505-586-1604
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 649
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City | QUESTA
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State | NM
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Zip | 87556-0649
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Country | US
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Telephone | 505-586-1092
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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 | 103TC1900X
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Taxonomy Name | Counseling Psychologist
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License Number | 283444
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License Number State | NM
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