Provider Demographics
NPI:1174678478
Name:REILLY, CHERYL M (MFTI)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:M
Last Name:REILLY
Suffix:
Gender:F
Credentials:MFTI
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3504 BREHME LN
Mailing Address - Street 2:
Mailing Address - City:VACAVILLE
Mailing Address - State:CA
Mailing Address - Zip Code:95688-9737
Mailing Address - Country:US
Mailing Address - Phone:707-446-7945
Mailing Address - Fax:
Practice Address - Street 1:14 N COTTONWOOD ST
Practice Address - Street 2:
Practice Address - City:WOODLAND
Practice Address - State:CA
Practice Address - Zip Code:95695-2585
Practice Address - Country:US
Practice Address - Phone:530-666-8983
Practice Address - Fax:530-666-8523
Is Sole Proprietor?:No
Enumeration Date:2007-01-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health