Provider Demographics
NPI:1538666532
Name:FOULTNER, CHERRY V
Entity Type:Individual
Prefix:
First Name:CHERRY
Middle Name:V
Last Name:FOULTNER
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1313 NE 134TH ST STE 220A
Mailing Address - Street 2:
Mailing Address - City:VANCOUVER
Mailing Address - State:WA
Mailing Address - Zip Code:98685-2722
Mailing Address - Country:US
Mailing Address - Phone:360-737-9792
Mailing Address - Fax:
Practice Address - Street 1:1313 NE 134TH ST STE 220A
Practice Address - Street 2:
Practice Address - City:VANCOUVER
Practice Address - State:WA
Practice Address - Zip Code:98685-2722
Practice Address - Country:US
Practice Address - Phone:360-737-9792
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2018-04-07
Last Update Date:2021-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALF61204764106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist