Provider Demographics
NPI:1912663840
Name:PENCE, CHERYL L (PHD, LPC, LPCC-S,NCC)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:L
Last Name:PENCE
Suffix:
Gender:F
Credentials:PHD, LPC, LPCC-S,NCC
Other - Prefix:DR
Other - First Name:CHERYL
Other - Middle Name:PENCE
Other - Last Name:WOLF
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD, LPC, LPCC-S,NCC
Mailing Address - Street 1:611 W COUPLES DR
Mailing Address - Street 2:
Mailing Address - City:COTTONWOOD
Mailing Address - State:AZ
Mailing Address - Zip Code:86326-4252
Mailing Address - Country:US
Mailing Address - Phone:352-870-1135
Mailing Address - Fax:
Practice Address - Street 1:12530 E ST FRANCIS WAY
Practice Address - Street 2:
Practice Address - City:CORNVILLE
Practice Address - State:AZ
Practice Address - Zip Code:86325-5950
Practice Address - Country:US
Practice Address - Phone:601-207-4554
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-11-15
Last Update Date:2021-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCC-S-252425101YP2500X
AZLPC-19977101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZNAOtherNA