Provider Demographics
NPI:1538272158
Name:OLIVER, CHERYL D (LMHC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:D
Last Name:OLIVER
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1100 CLEARWATER LARGO RD N
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:FL
Mailing Address - Zip Code:33770-4131
Mailing Address - Country:US
Mailing Address - Phone:727-518-6444
Mailing Address - Fax:727-581-2678
Practice Address - Street 1:1100 CLEARWATER LARGO RD N
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:FL
Practice Address - Zip Code:33770-4131
Practice Address - Country:US
Practice Address - Phone:727-518-6444
Practice Address - Fax:727-581-2678
Is Sole Proprietor?:No
Enumeration Date:2006-08-17
Last Update Date:2016-07-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS197101YP2500X
FLMH 7722101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL767656500Medicaid