Provider Demographics
NPI:1659773679
Name:MOBLEY, CHERYL (MEC, PLPC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:MOBLEY
Suffix:
Gender:F
Credentials:MEC, PLPC
Other - Prefix:
Other - First Name:SHERRE
Other - Middle Name:KATHLEEN
Other - Last Name:MOBLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MEC, PLPC
Mailing Address - Street 1:917 BROADWAY
Mailing Address - Street 2:
Mailing Address - City:HANNIBAL
Mailing Address - State:MO
Mailing Address - Zip Code:63401-4200
Mailing Address - Country:US
Mailing Address - Phone:573-221-2120
Mailing Address - Fax:573-221-4380
Practice Address - Street 1:917 BROADWAY
Practice Address - Street 2:
Practice Address - City:HANNIBAL
Practice Address - State:MO
Practice Address - Zip Code:63401-4200
Practice Address - Country:US
Practice Address - Phone:573-221-2120
Practice Address - Fax:573-221-4380
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-22
Last Update Date:2014-09-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2014033019101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional