Provider Demographics
NPI:1164941076
Name:MESIKANO, CHERYL R (LPC, LCDC, MAC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:R
Last Name:MESIKANO
Suffix:
Gender:F
Credentials:LPC, LCDC, MAC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3010 LBJ FWY STE 1270
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75234-7770
Mailing Address - Country:US
Mailing Address - Phone:469-540-3182
Mailing Address - Fax:
Practice Address - Street 1:3010 LBJ FWY STE 1270
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75234-7770
Practice Address - Country:US
Practice Address - Phone:469-540-3182
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-12
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13206101YA0400X
TX75272101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)