Provider Demographics
NPI:1205508132
Name:WALLEN, CHERYL (LMHCA)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:WALLEN
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5800 S OAKRIDGE DR LOT 40
Mailing Address - Street 2:
Mailing Address - City:HOMOSASSA
Mailing Address - State:FL
Mailing Address - Zip Code:34448-4948
Mailing Address - Country:US
Mailing Address - Phone:317-946-4979
Mailing Address - Fax:
Practice Address - Street 1:360 ARDMOOR DR
Practice Address - Street 2:
Practice Address - City:WHITELAND
Practice Address - State:IN
Practice Address - Zip Code:46184-1402
Practice Address - Country:US
Practice Address - Phone:317-946-4979
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-09-29
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88000548A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health