Provider Demographics
NPI:1851056014
Name:STICKELS, CHEYENNE NICOLE
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:NICOLE
Last Name:STICKELS
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 1:315 WASHINGTON ST
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:IN
Mailing Address - Zip Code:47201-6743
Mailing Address - Country:US
Mailing Address - Phone:812-413-9321
Mailing Address - Fax:812-413-9323
Practice Address - Street 1:315 WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:IN
Practice Address - Zip Code:47201-6743
Practice Address - Country:US
Practice Address - Phone:812-413-9321
Practice Address - Fax:812-413-9323
Is Sole Proprietor?:No
Enumeration Date:2021-11-03
Last Update Date:2023-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-1992276106S00000X
IN0-23-14596103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior Analyst
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician