Provider Demographics
NPI:1639218241
Name:ATKINS, CHERI L
Entity Type:Individual
Prefix:
First Name:CHERI
Middle Name:L
Last Name:ATKINS
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:PO BOX 4285
Mailing Address - Street 2:
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83205-4285
Mailing Address - Country:US
Mailing Address - Phone:208-236-1600
Mailing Address - Fax:
Practice Address - Street 1:1151 HOSPITAL WAY # D
Practice Address - Street 2:SUITE 204
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83201-2763
Practice Address - Country:US
Practice Address - Phone:208-237-2446
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-02-06
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ID103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist