Basic Information
| Provider Information | |||||||||
| NPI: | 1407096548 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | CUNNINGHAM | ||||||||
| FirstName: | CHRISTINE | ||||||||
| MiddleName: | LYNN | ||||||||
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| Credential: | MA, CADCI 00632 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 340 N 11TH ST | ||||||||
| Address2: | #100 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 891013125 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029227015 | ||||||||
| FaxNumber: | 7029226600 | ||||||||
| Practice Location | |||||||||
| Address1: | 304 N. 11TH ST. | ||||||||
| Address2: | #100 | ||||||||
| City: | LAS VEGAS | ||||||||
| State: | NV | ||||||||
| PostalCode: | 89101 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7029227015 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 03/03/2009 | ||||||||
| LastUpdateDate: | 03/03/2009 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YA0400X | 00632-INTERN | NV | Y | Behavioral Health & Social Service Providers | Counselor | Addiction (Substance Use Disorder) | 106H00000X | MASTERS | NV | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist |
No ID Information.