Provider Demographics
NPI:1174798375
Name:HARTUNG, CYNTHIA M (PHD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:M
Last Name:HARTUNG
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:507 S 4TH ST
Mailing Address - Street 2:SUITE A
Mailing Address - City:LARAMIE
Mailing Address - State:WY
Mailing Address - Zip Code:82070-3753
Mailing Address - Country:US
Mailing Address - Phone:307-460-0119
Mailing Address - Fax:307-742-4089
Practice Address - Street 1:507 S 4TH ST
Practice Address - Street 2:SUITE A
Practice Address - City:LARAMIE
Practice Address - State:WY
Practice Address - Zip Code:82070-3753
Practice Address - Country:US
Practice Address - Phone:307-460-0119
Practice Address - Fax:307-742-4089
Is Sole Proprietor?:Yes
Enumeration Date:2008-04-28
Last Update Date:2008-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY457103TC0700X, 103TC2200X, 103TM1800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC2200XBehavioral Health & Social Service ProvidersPsychologistClinical Child & Adolescent
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental Disabilities