Healthcare Provider Details

I. General information

NPI: 1881105518
Provider Name (Legal Business Name): CHERRY WULF
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/20/2017
Last Update Date: 02/21/2024
Certification Date: 02/21/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

701 5TH STREET
ARAPAHOE NE
68922-0618
US

IV. Provider business mailing address

1008 VINE ST
ARAPAHOE NE
68922-5552
US

V. Phone/Fax

Practice location:
  • Phone: 308-655-0014
  • Fax:
Mailing address:
  • Phone: 308-655-1097
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number5417
License Number StateNE
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2559
License Number StateNE
# 3
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNE
# 4
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number2974
License Number StateNE

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: