Basic Information
| Provider Information | |||||||||
| NPI: | 1942622949 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | BROWN | ||||||||
| FirstName: | CYNTHIA | ||||||||
| MiddleName: | |||||||||
| NamePrefix: | MRS. | ||||||||
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| Credential: | LPCC 5455 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 17701 SAN PASQUAL VALLEY RD | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920255301 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607414300 | ||||||||
| FaxNumber: | 7607414310 | ||||||||
| Practice Location | |||||||||
| Address1: | 1002 E GRAND AVE | ||||||||
| Address2: | |||||||||
| City: | ESCONDIDO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 920254605 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7608779893 | ||||||||
| FaxNumber: | |||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 01/09/2014 | ||||||||
| LastUpdateDate: | 02/11/2019 | ||||||||
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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 | 101YP2500X | 5455 | CA | N | 193200000X MULTI-SPECIALTY GROUP | Behavioral Health & Social Service Providers | Counselor | Professional | 101YP2500X | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.