Provider Demographics
NPI:1447738844
Name:DEHAVEN, CHERYL (MA, LPC, NCC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:DEHAVEN
Suffix:
Gender:F
Credentials:MA, LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:830 N HIGHWAY 191
Mailing Address - Street 2:
Mailing Address - City:PEARCE
Mailing Address - State:AZ
Mailing Address - Zip Code:85625-4064
Mailing Address - Country:US
Mailing Address - Phone:520-678-5851
Mailing Address - Fax:
Practice Address - Street 1:24 HOWELL AVE
Practice Address - Street 2:SUITE 11
Practice Address - City:BISBEE
Practice Address - State:AZ
Practice Address - Zip Code:85603-8562
Practice Address - Country:US
Practice Address - Phone:520-678-5851
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-07-30
Last Update Date:2018-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-17283101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional