Provider Demographics
NPI:1457454936
Name:OSWALT, CHERYL (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:OSWALT
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:410 PENINSULA CT
Mailing Address - Street 2:
Mailing Address - City:GRANBURY
Mailing Address - State:TX
Mailing Address - Zip Code:76048-2877
Mailing Address - Country:US
Mailing Address - Phone:501-563-8900
Mailing Address - Fax:
Practice Address - Street 1:104 MAVERICK ST
Practice Address - Street 2:
Practice Address - City:ALEDO
Practice Address - State:TX
Practice Address - Zip Code:76008-4450
Practice Address - Country:US
Practice Address - Phone:817-851-2042
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-09-07
Last Update Date:2019-08-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AR1104-C104100000X
TX681661041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No104100000XBehavioral Health & Social Service ProvidersSocial Worker
Provider Identifiers
StateIdentifier IDID TypeIssuer
AR132967002Medicaid