Healthcare Provider Details

I. General information

NPI: 1205145232
Provider Name (Legal Business Name): CHERYL DIANNE PLANERT LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 09/24/2010
Last Update Date: 09/24/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

530 FIRST ST., SE
BEACH ND
58621
US

IV. Provider business mailing address

PO BOX 982 530 FIRST ST., SE
BEACH ND
58621-0982
US

V. Phone/Fax

Practice location:
  • Phone: 701-872-2667
  • Fax:
Mailing address:
  • Phone: 701-872-2667
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number6
License Number StateND

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: