Provider Demographics
NPI:1952623555
Name:SEABURG, CHERYL DARLENE (LPC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:DARLENE
Last Name:SEABURG
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:PO BOX 9634
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64134-0634
Mailing Address - Country:US
Mailing Address - Phone:816-607-1430
Mailing Address - Fax:913-221-0152
Practice Address - Street 1:5100 NW WAUKOMIS DR
Practice Address - Street 2:SUITE E
Practice Address - City:KANSAS CITY
Practice Address - State:MO
Practice Address - Zip Code:64151-3508
Practice Address - Country:US
Practice Address - Phone:816-607-1430
Practice Address - Fax:913-221-0152
Is Sole Proprietor?:Yes
Enumeration Date:2010-02-23
Last Update Date:2010-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2009017758101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional