Provider Demographics
NPI:1134325491
Name:BALLOU, CHERYL ANN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:ANN
Last Name:BALLOU
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:DR
Other - First Name:CHERYL
Other - Middle Name:ANN
Other - Last Name:BALLOU
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:PSYD
Mailing Address - Street 1:68625 EVERWOOD CT
Mailing Address - Street 2:
Mailing Address - City:CATHEDRAL CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92234-4871
Mailing Address - Country:US
Mailing Address - Phone:951-264-8714
Mailing Address - Fax:442-268-9305
Practice Address - Street 1:68625 EVERWOOD CT
Practice Address - Street 2:
Practice Address - City:CATHEDRAL CITY
Practice Address - State:CA
Practice Address - Zip Code:92234-4871
Practice Address - Country:US
Practice Address - Phone:951-264-8714
Practice Address - Fax:442-268-9305
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-25
Last Update Date:2021-08-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSY24243103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical