=====================================================
General NPI Number Information
=====================================================
NPI Number | 1992864813
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CYNTHIA SUE FINCH LCSW
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 12/06/2006
-----------------------------------------------------
Last Update Date | 05/23/2017
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 831 WEST EULESS BLVD SUITE #3
-----------------------------------------------------
City | EULESS
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76040-4436
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-285-0204
-----------------------------------------------------
Fax | 817-864-9683
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 109 MANOR CT N
-----------------------------------------------------
City | WILLOW PARK
-----------------------------------------------------
State | TX
-----------------------------------------------------
Zip | 76087-3002
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 817-285-0204
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 1041C0700X
-----------------------------------------------------
Taxonomy Name | Clinical Social Worker
-----------------------------------------------------
License Number | LCSW28616
-----------------------------------------------------
License Number State | TX
-----------------------------------------------------