Provider Demographics
NPI:1053993899
Name:SHREWSBERRY, CYNTHIA B (LPC, LMFT, NCC)
Entity type:Individual
Prefix:MRS
First Name:CYNTHIA
Middle Name:B
Last Name:SHREWSBERRY
Suffix:
Gender:F
Credentials:LPC, LMFT, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 7452
Mailing Address - Street 2:
Mailing Address - City:LAKE CHARLES
Mailing Address - State:LA
Mailing Address - Zip Code:70606-7452
Mailing Address - Country:US
Mailing Address - Phone:337-478-1616
Mailing Address - Fax:337-478-1632
Practice Address - Street 1:108 STATE ST
Practice Address - Street 2:
Practice Address - City:LAKE CHARLES
Practice Address - State:LA
Practice Address - Zip Code:70605-5718
Practice Address - Country:US
Practice Address - Phone:337-478-1616
Practice Address - Fax:337-478-1616
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-21
Last Update Date:2021-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2665101YP2500X
LA707106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA1780740001OtherNPI TYPE 2