Provider Demographics
NPI:1396436085
Name:PE, CHERYL (PSYS , NCSP)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:
Last Name:PE
Suffix:
Gender:F
Credentials:PSYS , NCSP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4096 LIGUSTRUM DR
Mailing Address - Street 2:
Mailing Address - City:PALM HARBOR
Mailing Address - State:FL
Mailing Address - Zip Code:34685-3631
Mailing Address - Country:US
Mailing Address - Phone:727-215-3492
Mailing Address - Fax:
Practice Address - Street 1:6740 CROSSWINDS DR N UNIT L
Practice Address - Street 2:
Practice Address - City:SAINT PETERSBURG
Practice Address - State:FL
Practice Address - Zip Code:33710-8606
Practice Address - Country:US
Practice Address - Phone:727-599-3624
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLSS-1183103TS0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TS0200XBehavioral Health & Social Service ProvidersPsychologistSchool