Healthcare Provider Details

I. General information

NPI: 1194002113
Provider Name (Legal Business Name): CHERYL MEADOWS
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 11/04/2011
Last Update Date: 11/04/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

53 MARILYN MAE DR
SPARKS NV
89441-6236
US

IV. Provider business mailing address

53 MARILYN MAE DR
SPARKS NV
89441-6236
US

V. Phone/Fax

Practice location:
  • Phone: 775-247-4154
  • Fax:
Mailing address:
  • Phone: 775-247-4154
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code103TB0200X
TaxonomyCognitive & Behavioral Psychologist
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code103TR0400X
TaxonomyRehabilitation Psychologist
License Number
License Number State

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: