Provider Demographics
NPI:1346517521
Name:YOUNG-PELTON, CHERYL A
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:YOUNG-PELTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24 STAR HAVEN DR
Mailing Address - Street 2:
Mailing Address - City:ABSAROKEE
Mailing Address - State:MT
Mailing Address - Zip Code:59001-6244
Mailing Address - Country:US
Mailing Address - Phone:406-328-4956
Mailing Address - Fax:406-328-4956
Practice Address - Street 1:24 STAR HAVEN DR
Practice Address - Street 2:
Practice Address - City:ABSAROKEE
Practice Address - State:MT
Practice Address - Zip Code:59001-6244
Practice Address - Country:US
Practice Address - Phone:406-328-4956
Practice Address - Fax:406-328-4956
Is Sole Proprietor?:Yes
Enumeration Date:2011-11-16
Last Update Date:2021-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
1-10-7171103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst