Provider Demographics
NPI:1275622342
Name:PONDER, CHERYL LOUISE (MED,LPC,LMFT)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:LOUISE
Last Name:PONDER
Suffix:
Gender:F
Credentials:MED,LPC,LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11395 E ST HWY 9
Mailing Address - Street 2:
Mailing Address - City:NORMAN
Mailing Address - State:OK
Mailing Address - Zip Code:73026
Mailing Address - Country:US
Mailing Address - Phone:405-329-4848
Mailing Address - Fax:
Practice Address - Street 1:11395 E STATE HIGHWAY 9
Practice Address - Street 2:
Practice Address - City:NORMAN
Practice Address - State:OK
Practice Address - Zip Code:73026-8222
Practice Address - Country:US
Practice Address - Phone:405-329-4848
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK743106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist