MEDICARE: CYNTHIA LUNGSTRUM MSW, LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor	2003018404	MO
2	1041C0700X	Clinical Social Worker	2003018404	MO
3	1041C0700X	Clinical Social Worker	2424	KS

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1427129881
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CYNTHIA LUNGSTRUM MSW, LCSW

Provider Business Mailing Address
First Line	:	16262 VIXEN RD
Second Line	:
City	:	STARK CITY
State	:	MO
Zip	:	64866-7945
Country	:	US
Telephone Number	:	417-623-7852
Fax Number	:	888-310-7328

Provider Business Practice Location Address
First Line	:	16262 VIXEN RD
Second Line	:
City	:	STARK CITY
State	:	MO
Zip	:	64866-7945
Country	:	US
Telephone Number	:	417-388-9872
Fax Number	:	888-310-7328

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	11/10/2006
Last Update Date	:	09/16/2016

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