Provider Demographics
NPI:1700975158
Name:OSWALT, CHERYL LYNNE
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:LYNNE
Last Name:OSWALT
Suffix:
Gender:F
Credentials:
Other - Prefix:MISS
Other - First Name:CHERYL
Other - Middle Name:LYNNE
Other - Last Name:MILES
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:
Mailing Address - Street 1:1731 N COMAL STREET
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212
Mailing Address - Country:US
Mailing Address - Phone:210-404-9399
Mailing Address - Fax:210-481-7175
Practice Address - Street 1:1731 N COMAL STREET
Practice Address - Street 2:
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212
Practice Address - Country:US
Practice Address - Phone:210-404-9399
Practice Address - Fax:210-481-7175
Is Sole Proprietor?:No
Enumeration Date:2006-10-12
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15269101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor