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General NPI Number Information
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NPI Number | 1679730881
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Entity Type | Individual
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Provider Name | CYNTHIA GLINES PSY.D.
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Gender | Female
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Dates
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Enumeration Date | 05/16/2008
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Last Update Date | 11/18/2019
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Provider Practice Location Address
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Address Line | 9040 JACKSON AVE
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City | TACOMA
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State | WA
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Zip | 98431-0001
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Country | US
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Telephone | 253-968-5371
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 104
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City | GIG HARBOR
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State | WA
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Zip | 98335-0104
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Country | US
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Telephone | 253-968-5371
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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 | 1022
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License Number State | ID
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Taxonomy #2
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 015889
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License Number State | NY
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Taxonomy #3
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Taxonomy Code | 103TC0700X
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Taxonomy Name | Clinical Psychologist
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License Number | 20927
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License Number State | CA
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