Healthcare Provider Details

I. General information

NPI: 1578258125
Provider Name (Legal Business Name): RICKY DESHAUN CHERRY TLLP
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 04/10/2023
Last Update Date: 08/26/2025
Certification Date: 08/26/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

97 IONA AVENUE
MUSKEGON MI
49442
US

IV. Provider business mailing address

PO BOX 5042
MUSKEGON MI
49445
US

V. Phone/Fax

Practice location:
  • Phone: 231-760-6189
  • Fax: 231-760-6179
Mailing address:
  • Phone: 231-670-9878
  • Fax: 231-760-6179

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6362010064
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: