Healthcare Provider Details

I. General information

NPI: 1871873232
Provider Name (Legal Business Name): NICOLE CHERY PHD
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 08/17/2011
Last Update Date: 10/24/2025
Certification Date: 10/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

132 E BROADWAY STE 500
EUGENE OR
97401-3127
US

IV. Provider business mailing address

132 E BROADWAY STE 500
EUGENE OR
97401-3127
US

V. Phone/Fax

Practice location:
  • Phone: 678-404-2411
  • Fax:
Mailing address:
  • Phone: 678-404-2411
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number3160
License Number StateOR
# 2
Primary TaxonomyY
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number3160
License Number StateOR

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: