Provider Demographics
NPI:1861826372
Name:HEATH, CHERYL DIANNE
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:DIANNE
Last Name:HEATH
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 1:2655 MLK JR BLVD
Mailing Address - Street 2:
Mailing Address - City:EUGENE
Mailing Address - State:OR
Mailing Address - Zip Code:97401-5899
Mailing Address - Country:US
Mailing Address - Phone:541-682-7979
Mailing Address - Fax:541-682-7980
Practice Address - Street 1:2655 MLK JR BLVD
Practice Address - Street 2:
Practice Address - City:EUGENE
Practice Address - State:OR
Practice Address - Zip Code:97401-5899
Practice Address - Country:US
Practice Address - Phone:541-682-7979
Practice Address - Fax:541-682-7980
Is Sole Proprietor?:No
Enumeration Date:2013-09-03
Last Update Date:2013-09-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor