Provider Demographics
NPI:1720123300
Name:CHEROUTES, ELIZABETH (LCSW)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:
Last Name:CHEROUTES
Suffix:
Gender:F
Credentials:LCSW
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 12931
Mailing Address - Street 2:
Mailing Address - City:JACKSON
Mailing Address - State:WY
Mailing Address - Zip Code:83002-2931
Mailing Address - Country:US
Mailing Address - Phone:307-690-0484
Mailing Address - Fax:855-827-1278
Practice Address - Street 1:480 S CACHE ST
Practice Address - Street 2:15
Practice Address - City:JACKSON
Practice Address - State:WY
Practice Address - Zip Code:83001-8222
Practice Address - Country:US
Practice Address - Phone:307-690-0484
Practice Address - Fax:855-827-1278
Is Sole Proprietor?:No
Enumeration Date:2007-02-21
Last Update Date:2015-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WY1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical