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General NPI Number Information
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NPI Number | 1912663840
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Entity Type | Individual
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Provider Name | CHERYL L PENCE PHD, LPC, LPCC-S,NCC
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Gender | Female
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Dates
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Enumeration Date | 11/15/2021
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Last Update Date | 11/15/2021
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Provider Practice Location Address
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Address Line | 12530 E ST FRANCIS WAY
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City | CORNVILLE
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State | AZ
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Zip | 86325-5950
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Country | US
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Telephone | 601-207-4554
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Fax |
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Provider Business Mailing Address
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Address Line | 611 W COUPLES DR
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City | COTTONWOOD
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State | AZ
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Zip | 86326-4252
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Country | US
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Telephone | 352-870-1135
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPCC-S-252425
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License Number State | KY
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Taxonomy #2
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | LPC-19977
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License Number State | AZ
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