Healthcare Provider Details

I. General information

NPI: 1639140809
Provider Name (Legal Business Name): CHERYL ANNETTE HELTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: X

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

308 W CHURCH ST
AURORA MO
65605-1518
US

IV. Provider business mailing address

308 W CHURCH ST
AURORA MO
65605-1518
US

V. Phone/Fax

Practice location:
  • Phone: 417-678-5532
  • Fax: 417-678-6242
Mailing address:
  • Phone: 417-678-5532
  • Fax: 417-678-6242

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2003030545
License Number StateMO

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: