Provider Demographics
NPI:1164104337
Name:VISCARRA, CHERELLE
Entity Type:Individual
Prefix:
First Name:CHERELLE
Middle Name:
Last Name:VISCARRA
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 1:2511 TRIMMIER RD STE 14038
Mailing Address - Street 2:
Mailing Address - City:KILLEEN
Mailing Address - State:TX
Mailing Address - Zip Code:76542-1908
Mailing Address - Country:US
Mailing Address - Phone:254-394-8212
Mailing Address - Fax:
Practice Address - Street 1:2511 TRIMMIER RD STE 14038
Practice Address - Street 2:
Practice Address - City:KILLEEN
Practice Address - State:TX
Practice Address - Zip Code:76542-1908
Practice Address - Country:US
Practice Address - Phone:254-394-8212
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-08-07
Last Update Date:2023-08-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMT3943106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family TherapistGroup - Single Specialty