Provider Demographics
NPI:1750398913
Name:DAVIS, CYNTHIA A (LMHC,NCC,CCCJS)
Entity type:Individual
Prefix:
First Name:CYNTHIA
Middle Name:A
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LMHC,NCC,CCCJS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:100 E EUCLID AVE
Mailing Address - Street 2:SUITE 143
Mailing Address - City:DES MOINES
Mailing Address - State:IA
Mailing Address - Zip Code:50313-4511
Mailing Address - Country:US
Mailing Address - Phone:515-284-5211
Mailing Address - Fax:515-284-5211
Practice Address - Street 1:100 E EUCLID AVE
Practice Address - Street 2:SUITE 143
Practice Address - City:DES MOINES
Practice Address - State:IA
Practice Address - Zip Code:50313-4511
Practice Address - Country:US
Practice Address - Phone:515-284-5211
Practice Address - Fax:515-284-5211
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-01
Last Update Date:2008-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IALMHC 00092101YM0800X
IA00093103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
IA1125179Medicaid
IA29-77-024OtherDEPT. OF HUMAN SERVICES