Provider Demographics
NPI:1902485527
Name:UPCHURCH, CHERYL BASSETT (LCPC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:BASSETT
Last Name:UPCHURCH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:555 PRICE AVE
Mailing Address - Street 2:
Mailing Address - City:CALUMET CITY
Mailing Address - State:IL
Mailing Address - Zip Code:60409-3531
Mailing Address - Country:US
Mailing Address - Phone:708-862-7255
Mailing Address - Fax:
Practice Address - Street 1:555 PRICE AVE
Practice Address - Street 2:
Practice Address - City:CALUMET CITY
Practice Address - State:IL
Practice Address - Zip Code:60409-3531
Practice Address - Country:US
Practice Address - Phone:708-862-7255
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-04-02
Last Update Date:2021-04-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional