Provider Demographics
NPI:1275042715
Name:CONGROVE, CHERYL LYN (LPC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYN
Last Name:CONGROVE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:LYN
Other - Last Name:STUDER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1453 W LIBBY LOOP RD
Mailing Address - Street 2:
Mailing Address - City:PRESCOTT
Mailing Address - State:AZ
Mailing Address - Zip Code:86303-6153
Mailing Address - Country:US
Mailing Address - Phone:928-713-9090
Mailing Address - Fax:928-713-9090
Practice Address - Street 1:1453 W LIBBY LOOP RD
Practice Address - Street 2:
Practice Address - City:PRESCOTT
Practice Address - State:AZ
Practice Address - Zip Code:86303-6153
Practice Address - Country:US
Practice Address - Phone:928-713-9090
Practice Address - Fax:928-713-9090
Is Sole Proprietor?:Yes
Enumeration Date:2017-09-27
Last Update Date:2022-07-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-16802101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional