Provider Demographics
NPI:1710198403
Name:WHITTENBERG, CHERYL LYNN (MED)
Entity Type:Individual
Prefix:MISS
First Name:CHERYL
Middle Name:LYNN
Last Name:WHITTENBERG
Suffix:
Gender:F
Credentials:MED
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 550
Mailing Address - Street 2:113 COUNTY ROAD 2272
Mailing Address - City:SALTILLO
Mailing Address - State:MS
Mailing Address - Zip Code:38866-0550
Mailing Address - Country:US
Mailing Address - Phone:662-840-3008
Mailing Address - Fax:662-841-0337
Practice Address - Street 1:252 S VETERANS BLVD
Practice Address - Street 2:
Practice Address - City:TUPELO
Practice Address - State:MS
Practice Address - Zip Code:38804-5022
Practice Address - Country:US
Practice Address - Phone:662-840-3008
Practice Address - Fax:662-841-0337
Is Sole Proprietor?:No
Enumeration Date:2007-05-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor