Provider Demographics
NPI:1568974806
Name:DAVIS, CHERYL ANN (MA)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5197 SAN ANSELMO ST
Mailing Address - Street 2:
Mailing Address - City:LAS VEGAS
Mailing Address - State:NV
Mailing Address - Zip Code:89120-1746
Mailing Address - Country:US
Mailing Address - Phone:209-602-0827
Mailing Address - Fax:
Practice Address - Street 1:1481 W WARM SPRINGS RD STE 132
Practice Address - Street 2:
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89014-7653
Practice Address - Country:US
Practice Address - Phone:702-907-4143
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-26
Last Update Date:2022-10-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NVMI0744106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist