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General NPI Number Information
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NPI Number | 1609247022
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Entity Type | Individual
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Provider Name | CYNTHIA ANN MCCONVILLE LMHC
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Gender | Female
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Dates
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Enumeration Date | 10/12/2015
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Last Update Date | 11/18/2016
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Provider Practice Location Address
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Address Line | 1437 S BELCHER RD
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City | CLEARWATER
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State | FL
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Zip | 33764-2829
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Country | US
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Telephone | 727-524-4464
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Fax |
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Provider Business Mailing Address
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Address Line | 1411 ISLAND DR S
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City | SOUTH PASADENA
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State | FL
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Zip | 33707-3713
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Country | US
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Telephone | 651-210-3777
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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 | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | MH 12931
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License Number State | FL
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Taxonomy #2
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 5056
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License Number State | FL
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Taxonomy #3
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 01674
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License Number State | MN
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Taxonomy #4
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Taxonomy Code | 101YA0400X
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Taxonomy Name | Addiction (Substance Use Disorder) Counselor
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License Number | 302576
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License Number State | MN
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