Provider Demographics
NPI:1871646802
Name:SMITH, CHERYL A (MS, LPC)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:A
Last Name:SMITH
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4021 E GABLE CIR
Mailing Address - Street 2:
Mailing Address - City:MESA
Mailing Address - State:AZ
Mailing Address - Zip Code:85206-3204
Mailing Address - Country:US
Mailing Address - Phone:602-690-8079
Mailing Address - Fax:480-659-5071
Practice Address - Street 1:4021 E GABLE CIR
Practice Address - Street 2:
Practice Address - City:MESA
Practice Address - State:AZ
Practice Address - Zip Code:85206-3204
Practice Address - Country:US
Practice Address - Phone:602-690-8079
Practice Address - Fax:480-659-5071
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-10225101YP2500X
UT319064-6004101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional