Provider Demographics
NPI:1861037608
Name:NIX, CHERYL A (LCSW)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:A
Last Name:NIX
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:CHERYL
Other - Middle Name:A
Other - Last Name:NIX
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCSW
Mailing Address - Street 1:190 NW 4TH ST
Mailing Address - Street 2:
Mailing Address - City:PRINEVILLE
Mailing Address - State:OR
Mailing Address - Zip Code:97754-1820
Mailing Address - Country:US
Mailing Address - Phone:541-416-3697
Mailing Address - Fax:541-416-3707
Practice Address - Street 1:190 NW 4TH ST
Practice Address - Street 2:
Practice Address - City:PRINEVILLE
Practice Address - State:OR
Practice Address - Zip Code:97754-1820
Practice Address - Country:US
Practice Address - Phone:541-416-3697
Practice Address - Fax:541-416-3707
Is Sole Proprietor?:Yes
Enumeration Date:2019-11-15
Last Update Date:2020-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORL78781041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical