Provider Demographics
NPI:1508221821
Name:CHEATHAM, HARVEY (PHD)
Entity Type:Individual
Prefix:
First Name:HARVEY
Middle Name:
Last Name:CHEATHAM
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:29755 ANTHONY RD
Mailing Address - Street 2:
Mailing Address - City:VALLEY CENTER
Mailing Address - State:CA
Mailing Address - Zip Code:92082-4035
Mailing Address - Country:US
Mailing Address - Phone:760-845-1571
Mailing Address - Fax:
Practice Address - Street 1:29755 ANTHONY RD
Practice Address - Street 2:
Practice Address - City:VALLEY CENTER
Practice Address - State:CA
Practice Address - Zip Code:92082-4035
Practice Address - Country:US
Practice Address - Phone:760-845-1571
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2015-12-31
Last Update Date:2015-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist