Provider Demographics
NPI:1649385469
Name:CHERVENAK, JOHN PATRICK (MRC, CRC, LP)
Entity Type:Individual
Prefix:
First Name:JOHN
Middle Name:PATRICK
Last Name:CHERVENAK
Suffix:
Gender:M
Credentials:MRC, CRC, LP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1631 SEIFERT DR
Mailing Address - Street 2:
Mailing Address - City:POPLAR BLUFF
Mailing Address - State:MO
Mailing Address - Zip Code:63901-2555
Mailing Address - Country:US
Mailing Address - Phone:573-686-6453
Mailing Address - Fax:573-686-6504
Practice Address - Street 1:1906 GREENWOOD DR # B
Practice Address - Street 2:
Practice Address - City:POPLAR BLUFF
Practice Address - State:MO
Practice Address - Zip Code:63901-2430
Practice Address - Country:US
Practice Address - Phone:573-778-0705
Practice Address - Fax:573-778-0925
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-20
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2004011118101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional