Basic Information
Provider Information
NPI: 1033557962
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: MEREDITH
FirstName: CYNTHIA
MiddleName: S
NamePrefix: MS.
NameSuffix:  
Credential: LPCC
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 2271 HODGENVILLE RD
Address2:  
City: ELIZABETHTOWN
State: KY
PostalCode: 427018145
CountryCode: US
TelephoneNumber: 2702346139
FaxNumber:  
Practice Location
Address1: 2272 HODGENVILLE ROAD
Address2:  
City: ELIZABETHTOWN
State: KY
PostalCode: 42701
CountryCode: US
TelephoneNumber: 2702346139
FaxNumber:  
Other Information
ProviderEnumerationDate: 06/13/2013
LastUpdateDate: 08/17/2015
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: F
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: Y
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X1714KYY Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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