Provider Demographics
NPI:1538300884
Name:OLIVER, CHERYL L (MA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:L
Last Name:OLIVER
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:L
Other - Last Name:WITHERS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:2909 SUN MEADOW DRIVE
Mailing Address - Street 2:
Mailing Address - City:FLOWER MOUND
Mailing Address - State:TX
Mailing Address - Zip Code:75022
Mailing Address - Country:US
Mailing Address - Phone:817-907-6060
Mailing Address - Fax:
Practice Address - Street 1:2301 OLYMPIA DRIVE
Practice Address - Street 2:#100
Practice Address - City:FLOWER MOUND
Practice Address - State:TX
Practice Address - Zip Code:75028
Practice Address - Country:US
Practice Address - Phone:817-907-6060
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-03-17
Last Update Date:2009-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63101101YP2500X
TX201118106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist