Provider Demographics
NPI:1538362413
Name:MANTLE, CHERYL R (MA, LMHC, NCC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:R
Last Name:MANTLE
Suffix:
Gender:F
Credentials:MA, LMHC, NCC
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 2970
Mailing Address - Street 2:
Mailing Address - City:PORT ANGELES
Mailing Address - State:WA
Mailing Address - Zip Code:98362-0336
Mailing Address - Country:US
Mailing Address - Phone:360-452-2260
Mailing Address - Fax:360-452-1860
Practice Address - Street 1:113 S EUNICE ST
Practice Address - Street 2:
Practice Address - City:PORT ANGELES
Practice Address - State:WA
Practice Address - Zip Code:98362-3333
Practice Address - Country:US
Practice Address - Phone:360-452-2260
Practice Address - Fax:360-452-1860
Is Sole Proprietor?:Yes
Enumeration Date:2007-06-07
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WALH00007247101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health