Provider Demographics
NPI:1558560896
Name:MATHIS, CHERYL S (LCSW, LSCSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:S
Last Name:MATHIS
Suffix:
Gender:F
Credentials:LCSW, LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4121 E VALLEY AUTO DR STE 122
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-4632
Mailing Address - Country:US
Mailing Address - Phone:602-285-9696
Mailing Address - Fax:602-277-5930
Practice Address - Street 1:4121 E VALLEY AUTO DR STE 122
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-4632
Practice Address - Country:US
Practice Address - Phone:602-285-9696
Practice Address - Fax:602-277-5930
Is Sole Proprietor?:No
Enumeration Date:2007-07-17
Last Update Date:2015-05-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS39551041C0700X
AZ151891041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZZ169001Medicare PIN