Provider Demographics
NPI:1528628484
Name:MCKINZIE, CYNTHIA LYNNE (PSYD)
Entity type:Individual
Prefix:DR
First Name:CYNTHIA
Middle Name:LYNNE
Last Name:MCKINZIE
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CYNTHIA
Other - Middle Name:LYNNE
Other - Last Name:CHATEL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:3600 N LAKE SHORE DR APT 2608
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60613-4666
Mailing Address - Country:US
Mailing Address - Phone:847-563-0502
Mailing Address - Fax:
Practice Address - Street 1:3600 N LAKE SHORE DR APT 2608
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60613-4666
Practice Address - Country:US
Practice Address - Phone:847-563-0502
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2019-06-13
Last Update Date:2023-06-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL071007162103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical