Provider Demographics
NPI:1922123447
Name:SELLERS, CHERITI (BS, ICADC)
Entity Type:Individual
Prefix:MRS
First Name:CHERITI
Middle Name:
Last Name:SELLERS
Suffix:
Gender:F
Credentials:BS, ICADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:109 W 9TH ST
Mailing Address - Street 2:
Mailing Address - City:CHANDLER
Mailing Address - State:OK
Mailing Address - Zip Code:74834-3601
Mailing Address - Country:US
Mailing Address - Phone:405-258-2600
Mailing Address - Fax:405-258-2606
Practice Address - Street 1:109 W 9TH ST
Practice Address - Street 2:
Practice Address - City:CHANDLER
Practice Address - State:OK
Practice Address - Zip Code:74834-3601
Practice Address - Country:US
Practice Address - Phone:405-258-2600
Practice Address - Fax:405-258-2606
Is Sole Proprietor?:No
Enumeration Date:2007-03-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK23125101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)