Provider Demographics
NPI:1417192758
Name:NEWTON, CHERISSA S (CPCI)
Entity Type:Individual
Prefix:
First Name:CHERISSA
Middle Name:S
Last Name:NEWTON
Suffix:
Gender:F
Credentials:CPCI
Other - Prefix:
Other - First Name:CHERISSA
Other - Middle Name:
Other - Last Name:STOWELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:CPCI
Mailing Address - Street 1:11317 S 2450 W
Mailing Address - Street 2:
Mailing Address - City:SOUTH JORDAN
Mailing Address - State:UT
Mailing Address - Zip Code:84095-8773
Mailing Address - Country:US
Mailing Address - Phone:801-718-8131
Mailing Address - Fax:
Practice Address - Street 1:9263 REDWOOD RD
Practice Address - Street 2:
Practice Address - City:WEST JORDAN
Practice Address - State:UT
Practice Address - Zip Code:84088-6571
Practice Address - Country:US
Practice Address - Phone:801-566-0749
Practice Address - Fax:801-566-7108
Is Sole Proprietor?:No
Enumeration Date:2008-12-15
Last Update Date:2008-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
UT7190911-6009101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional