Basic Information
| Provider Information | |||||||||
| NPI: | 1760889489 | ||||||||
| EntityType: | 1 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | |||||||||
| LastName: | NELSON | ||||||||
| FirstName: | CHERRY | ||||||||
| MiddleName: | LYNN | ||||||||
| NamePrefix: | MRS. | ||||||||
| NameSuffix: | |||||||||
| Credential: | LPCC-S | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1200 E WHEELING AVE | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437252510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404321800 | ||||||||
| FaxNumber: | 7404329299 | ||||||||
| Practice Location | |||||||||
| Address1: | 1200 E WHEELING AVE | ||||||||
| Address2: | |||||||||
| City: | CAMBRIDGE | ||||||||
| State: | OH | ||||||||
| PostalCode: | 437252510 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7404321800 | ||||||||
| FaxNumber: | 7404329299 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 11/24/2014 | ||||||||
| LastUpdateDate: | 08/16/2021 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | N | ||||||||
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| NPICertificationDate: | 08/16/2021 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YP2500X | E.1700327-SUPV | OH | Y | Behavioral Health & Social Service Providers | Counselor | Professional |
No ID Information.