Provider Demographics
NPI:1982363149
Name:HANCE, CHEYENNE SKYE
Entity Type:Individual
Prefix:
First Name:CHEYENNE
Middle Name:SKYE
Last Name:HANCE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:722 HARVARD DR
Mailing Address - Street 2:
Mailing Address - City:OWENSBORO
Mailing Address - State:KY
Mailing Address - Zip Code:42301-6152
Mailing Address - Country:US
Mailing Address - Phone:270-240-1824
Mailing Address - Fax:270-478-4879
Practice Address - Street 1:722 HARVARD DR
Practice Address - Street 2:
Practice Address - City:OWENSBORO
Practice Address - State:KY
Practice Address - Zip Code:42301-6152
Practice Address - Country:US
Practice Address - Phone:270-240-1824
Practice Address - Fax:270-478-4879
Is Sole Proprietor?:Yes
Enumeration Date:2021-12-14
Last Update Date:2021-12-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
INRBT-21-164982106S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106S00000XBehavioral Health & Social Service ProvidersBehavior Technician