| NPI | 1366570616 |
|---|---|
| Former Name | CYNTHIA JEAN NICKLESS |
| Entity Type | Individual |
| Gender | Female |
| Sole Proprietor ? | Yes |
| Primary Taxonomy | 103TC0700X Psychologist Clinical (Licence: PA PS016943) |
| Additional Taxonomies | 103TC0700X Psychologist Clinical (Licence: OH 5859) |
| Enumeration Date | 2007-03-01 |
| Last Update Date | 2011-01-20 |