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General NPI Number Information
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NPI Number | 1972714681
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Entity Type | Individual
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Provider Name | CYNTHIA ANN CLEGG MA,,LMHC
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Gender | Female
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Dates
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Enumeration Date | 05/24/2007
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Last Update Date | 07/08/2007
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Provider Practice Location Address
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Address Line | 2814 S US HIGHWAY 1 STE D4
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City | FORT PIERCE
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State | FL
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Zip | 34982-8110
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Country | US
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Telephone | 772-489-4726
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Fax | 772-489-0423
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Provider Business Mailing Address
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Address Line | 9836 PERFECT DR
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City | PORT ST LUCIE
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State | FL
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Zip | 34986-3031
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Country | US
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Telephone | 772-489-4726
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Fax | 772-489-0423
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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 5442
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License Number State | FL
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