Provider Demographics
NPI:1639189525
Name:BEDWELL, CHERISH MARIE (LMFT)
Entity Type:Individual
Prefix:
First Name:CHERISH
Middle Name:MARIE
Last Name:BEDWELL
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9401 E STOCKTON BLVD STE 250
Mailing Address - Street 2:
Mailing Address - City:ELK GROVE
Mailing Address - State:CA
Mailing Address - Zip Code:95624-5053
Mailing Address - Country:US
Mailing Address - Phone:916-834-3486
Mailing Address - Fax:
Practice Address - Street 1:9401 E STOCKTON BLVD STE 250
Practice Address - Street 2:
Practice Address - City:ELK GROVE
Practice Address - State:CA
Practice Address - Zip Code:95624-5053
Practice Address - Country:US
Practice Address - Phone:916-834-3486
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-09
Last Update Date:2009-06-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC 43700106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
CA000008462OtherMEDI-CAL PROVIDER #