MEDICARE: ELIZABETH CHEROUTES LCSW

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	1041C0700X	Clinical Social Worker		WY

General Provider Information

NPI Number	:	1720123300
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH CHEROUTES LCSW

Provider Business Mailing Address
First Line	:	PO BOX 12931
Second Line	:
City	:	JACKSON
State	:	WY
Zip	:	83002-2931
Country	:	US
Telephone Number	:	307-690-0484
Fax Number	:	855-827-1278

Provider Business Practice Location Address
First Line	:	480 S CACHE ST
Second Line	:	15
City	:	JACKSON
State	:	WY
Zip	:	83001-8222
Country	:	US
Telephone Number	:	307-690-0484
Fax Number	:	855-827-1278

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	02/21/2007
Last Update Date	:	02/09/2015

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