=====================================================
General NPI Number Information
=====================================================
NPI Number | 1962030932
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA MICHELLE GERI
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/27/2020
-----------------------------------------------------
Last Update Date | 03/27/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 220 DAVIS RD
-----------------------------------------------------
City | COMBINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75159-5857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-849-3993
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 220 DAVIS RD
-----------------------------------------------------
City | COMBINE
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 75159-5857
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 972-849-3993
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 101Y00000X
-----------------------------------------------------
Taxonomy Name | Counselor
-----------------------------------------------------
License Number | 15995
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------