Provider Demographics
NPI:1205956828
Name:PETERSON, CHERYL LYNN (MS)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:LYNN
Last Name:PETERSON
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 4452
Mailing Address - Street 2:
Mailing Address - City:SONORA
Mailing Address - State:CA
Mailing Address - Zip Code:95370-1452
Mailing Address - Country:US
Mailing Address - Phone:209-559-2432
Mailing Address - Fax:209-532-5003
Practice Address - Street 1:531 S WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:SONORA
Practice Address - State:CA
Practice Address - Zip Code:95370-5114
Practice Address - Country:US
Practice Address - Phone:209-559-2432
Practice Address - Fax:209-559-2432
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-29
Last Update Date:2022-09-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALMFT 46514106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist