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NPI Code Detail

MEDICARE: CYNTHIA WHITE MS, LAC

MEDICARE: CYNTHIA WHITE MS, LAC
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
1101YA0400XAddiction (Substance Use Disorder) CounselorACD.0000925CO

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1472809995OTHERCOADVANCED RECOVERY SYSTEMS, LLC

General Provider Information

NPI Number : 1760998892
Entity Type Code : Individual
Provider Name (Legal Business Name) : CYNTHIA WHITE MS, LAC
Provider Business Mailing Address
First Line : 443 HIGHWAY 105
Second Line :
City : PALMER LAKE
State : CO
Zip : 80133-9003
Country : US
Telephone Number : 719-955-1800
Fax Number :
Provider Business Practice Location Address
First Line : 443 HIGHWAY 105
Second Line :
City : PALMER LAKE
State : CO
Zip : 80133-9003
Country : US
Telephone Number : 719-955-1800
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 12/27/2017
Last Update Date : 12/27/2017

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Directions to “ CYNTHIA WHITE MS, LAC” Practice Location

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