MEDICARE: CYPRESS COUNSELING CENTER, PLLC

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	251B00000X	Case Management Agency
2	251S00000X	Community/Behavioral Health Agency
3	261QM0801X	Mental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number	:	1497419600
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CYPRESS COUNSELING CENTER, PLLC

Provider Business Mailing Address
First Line	:	804 STAMPER RD STE 102
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-4163
Country	:	US
Telephone Number	:	910-229-3888
Fax Number	:

Provider Business Practice Location Address
First Line	:	804 STAMPER RD STE 102
Second Line	:
City	:	FAYETTEVILLE
State	:	NC
Zip	:	28303-4163
Country	:	US
Telephone Number	:	910-229-3888
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	CRYSTAL GAYNELL DEPIETRO
Credential	:	LCSW, CCM
Telephone Number	:	910-551-0835

Provider Enumeration Date	:	10/25/2021
Last Update Date	:	05/08/2023

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