Provider Demographics
NPI:1659430106
Name:LEBEAU, CHERYL OUIMET (LMSW, BCD)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:OUIMET
Last Name:LEBEAU
Suffix:
Gender:F
Credentials:LMSW, BCD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:JBLM MADIGAN ARMY MEDICAL CTR
Mailing Address - Street 2:9920 E. JOHNSON ST.
Mailing Address - City:TACOMA
Mailing Address - State:WA
Mailing Address - Zip Code:98431-0001
Mailing Address - Country:US
Mailing Address - Phone:253-968-4851
Mailing Address - Fax:
Practice Address - Street 1:JBLM MADIGAN ARMY MEDICAL CTR
Practice Address - Street 2:9920 E. JOHNSON ST.
Practice Address - City:TACOMA
Practice Address - State:WA
Practice Address - Zip Code:98431-0001
Practice Address - Country:US
Practice Address - Phone:253-968-4851
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-12-08
Last Update Date:2016-04-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI68010656671041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI8008954920Medicare UPIN
MION22890Medicare ID - Type UnspecifiedMEDICARE
MI7828287OtherAETNA