Provider Demographics
NPI:1952137507
Name:EVANS, CHERYL KATHLEEN (LPC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:KATHLEEN
Last Name:EVANS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9241 W RIDGEWAY DR
Mailing Address - Street 2:
Mailing Address - City:CADDO
Mailing Address - State:OK
Mailing Address - Zip Code:74729-5275
Mailing Address - Country:US
Mailing Address - Phone:469-667-4193
Mailing Address - Fax:
Practice Address - Street 1:2902 W UNIVERSITY BLVD
Practice Address - Street 2:
Practice Address - City:DURANT
Practice Address - State:OK
Practice Address - Zip Code:74701-2975
Practice Address - Country:US
Practice Address - Phone:469-667-4193
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-09-10
Last Update Date:2024-09-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX88667101YP2500X
OK12279101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional