Provider Demographics
NPI:1477954303
Name:CYR, CHERYL (MA, QS, LMHC, NCC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:CYR
Suffix:
Gender:F
Credentials:MA, QS, LMHC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 AMBERSWEET WAY # 537
Mailing Address - Street 2:
Mailing Address - City:DAVENPORT
Mailing Address - State:FL
Mailing Address - Zip Code:33897-8418
Mailing Address - Country:US
Mailing Address - Phone:813-858-3413
Mailing Address - Fax:
Practice Address - Street 1:1420 CELEBRATION BLVD STE 200
Practice Address - Street 2:
Practice Address - City:CELEBRATION
Practice Address - State:FL
Practice Address - Zip Code:34747-5162
Practice Address - Country:US
Practice Address - Phone:813-858-3413
Practice Address - Fax:863-438-7142
Is Sole Proprietor?:No
Enumeration Date:2014-09-10
Last Update Date:2024-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH14934101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL020648700Medicaid