Provider Demographics
NPI:1154648558
Name:MATHEWS, CHERI L (BA/PSRS)
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:L
Last Name:MATHEWS
Suffix:
Gender:F
Credentials:BA/PSRS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:21938 COGGINS RD
Mailing Address - Street 2:
Mailing Address - City:POTEAU
Mailing Address - State:OK
Mailing Address - Zip Code:74953-8678
Mailing Address - Country:US
Mailing Address - Phone:918-649-0909
Mailing Address - Fax:
Practice Address - Street 1:21938 COGGINS RD
Practice Address - Street 2:
Practice Address - City:POTEAU
Practice Address - State:OK
Practice Address - Zip Code:74953-8678
Practice Address - Country:US
Practice Address - Phone:918-649-0909
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-23
Last Update Date:2010-04-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitation