Fondren, Cynthia L
Fondren, Cynthia L is an sole proprietor health care provider with primary practice located at 1830 Destiny Ln Ste 104 , Bowling Green KY 42104. She recently has 2 registered licenses in different health care specialties including Behavioral Health & Social Service Providers / Marriage & Family Therapist, Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder). Behavioral Health & Social Service Providers / Marriage & Family Therapist is her primary health care specialty. Fondren, Cynthia L can be contacted via phone (270) 901-5000.Contact Information
Primary practice address
1830 Destiny Ln Ste 104
Bowling Green KY 42104
Phone: (270) 901-5000
Fax:
Website:
Health care specialties
| Specialty | Code | License # | State |
|---|---|---|---|
| Behavioral Health & Social Service Providers / Marriage & Family Therapist | 106H00000X | 241316 | Kentucky |
| Behavioral Health & Social Service Providers / Addiction (Substance Use Disorder) | 101YA0400X |
Profile Details
| NPI number | 1801930425 |
|---|---|
| LBN Legal business name | Fondren, Cynthia L |
| Credentials | LMFT |
| Entity | Individual |
| Sole proprietor 1 | Yes |
| Enumeration date | Feb 16th, 2007 |
| Last updated | Jul 2nd, 2019 - about 7 years ago |
1 A sole proprietor/sole proprietorship is an individual, and in that capacity, is qualified for a solitary NPI number. The sole proprietor have to apply for the NPI number using his or her own particular Social Security Number (SSN), instead of Employer Identification Number (EIN) regardless of whether he/she has an EIN.
Identifiers
| State | Type | Number | Issuer |
|---|---|---|---|
| All States | NPI | 1801930425 | NPPES |
| Other | 830848596 | FEDERAL TAX ID | |
| MEDICAID | 30604011 | FEDERAL TAX ID |
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