Healthcare Provider Details

I. General information

NPI: 1336590892
Provider Name (Legal Business Name): CHERYL FRALEY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/27/2016
Last Update Date: 06/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1408 NW 6TH STREET
GAINESVILLE FL
32601
US

IV. Provider business mailing address

1408 NW 6TH STREET
GAINESVILLE FL
32601
US

V. Phone/Fax

Practice location:
  • Phone: 352-373-4411
  • Fax: 352-373-4455
Mailing address:
  • Phone: 352-373-4411
  • Fax: 352-373-4455

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMH7881
License Number StateFL
# 2
Primary TaxonomyY
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number1-01-0708
License Number StateFL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: