Individual
CYNTHIA L FONDREN
Active
Sole proprietor
Yes
Provider details
NPI number
Gender
F
Credential
LMFT
Contact information
Practice address
1830 DESTINY LN STE 104, BOWLING GREEN, KY 42104
(270) 901-5000
Mailing address
1830 DESTINY LN STE 104, BOWLING GREEN, KY 42104-1088
(513) 341-0500
Taxonomy
Speciality
Code
Description
License number
State
101YA0400X
Addiction (Substance Use Disorder) Counselor
—
—
106H00000X
Marriage & Family Therapist
Primary
241316
KY
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
30604011
—
KY
01
—
830848596
FEDERAL TAX ID
—
Enumeration date
02/16/2007
Last updated
07/02/2019
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