Provider Demographics
NPI:1114523511
Name:BERRY, CHEYENNE
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:
Last Name:BERRY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:KAISER PERMANENTE BEHAVIORAL HEALTH CENTER
Mailing Address - Street 2:3840 HOMESTEAD ROAD
Mailing Address - City:SANTA CLARA
Mailing Address - State:CA
Mailing Address - Zip Code:95051
Mailing Address - Country:US
Mailing Address - Phone:408-851-4923
Mailing Address - Fax:408-851-4925
Practice Address - Street 1:KAISER PERMANENTE BEHAVIORAL HEALTH CENTER
Practice Address - Street 2:3840 HOMESTEAD ROAD
Practice Address - City:SANTA CLARA
Practice Address - State:CA
Practice Address - Zip Code:95051
Practice Address - Country:US
Practice Address - Phone:408-851-4923
Practice Address - Fax:408-851-4925
Is Sole Proprietor?:No
Enumeration Date:2020-12-10
Last Update Date:2023-03-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAAMFT90521101YM0800X
CA127298101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health