Provider Demographics
NPI:1477603769
Name:CHERRY, DEBBIE L (PHD)
Entity Type:Individual
Prefix:DR
First Name:DEBBIE
Middle Name:L
Last Name:CHERRY
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1111 S GLENSTONE AVE
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SPRINGFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:65804-0313
Mailing Address - Country:US
Mailing Address - Phone:417-862-8282
Mailing Address - Fax:417-862-8805
Practice Address - Street 1:1111 S GLENSTONE AVE
Practice Address - Street 2:SUITE 201
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804-0313
Practice Address - Country:US
Practice Address - Phone:417-862-8282
Practice Address - Fax:417-862-8805
Is Sole Proprietor?:No
Enumeration Date:2007-01-11
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO01641103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO496958018Medicaid
MO110032OtherBCBS PROVIDER NUMBER
MO000070884Medicare ID - Type UnspecifiedPROVIDER NUMBER