Provider Demographics
NPI:1316003759
Name:THORNTON, CHERYL (PSYD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:THORNTON
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:
Other - Last Name:CAWLFIELD
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 610
Mailing Address - Street 2:
Mailing Address - City:STOCKTON
Mailing Address - State:MO
Mailing Address - Zip Code:65785-0610
Mailing Address - Country:US
Mailing Address - Phone:417-522-9124
Mailing Address - Fax:
Practice Address - Street 1:808 SOUTH ST
Practice Address - Street 2:
Practice Address - City:STOCKTON
Practice Address - State:MO
Practice Address - Zip Code:65785
Practice Address - Country:US
Practice Address - Phone:417-522-9124
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-29
Last Update Date:2018-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2006034087103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist