Provider Demographics
NPI:1528383205
Name:HARRIS, CHERYLL JOYCE
Entity Type:Individual
Prefix:MRS
First Name:CHERYLL
Middle Name:JOYCE
Last Name:HARRIS
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CHERYLL
Other - Middle Name:JOYCE
Other - Last Name:DEVEREAUX
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:1606 NOB HILL DR
Mailing Address - Street 2:
Mailing Address - City:DUNCANVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:75137-3736
Mailing Address - Country:US
Mailing Address - Phone:972-709-8753
Mailing Address - Fax:972-907-8753
Practice Address - Street 1:725 YALE DR
Practice Address - Street 2:
Practice Address - City:LANCASTER
Practice Address - State:TX
Practice Address - Zip Code:75134-2525
Practice Address - Country:US
Practice Address - Phone:817-915-9731
Practice Address - Fax:817-915-9731
Is Sole Proprietor?:Yes
Enumeration Date:2010-04-06
Last Update Date:2010-04-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities