MEDICARE: CHERYL LYNN COHEN QMHP,CADC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YA0400X	Addiction (Substance Use Disorder) Counselor
2	101YM0800X	Mental Health Counselor

General Provider Information

NPI Number	:	1689680902
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL LYNN COHEN QMHP,CADC

Provider Business Mailing Address
First Line	:	2051 KAEN RD
Second Line	:	SUITE 367
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4035
Country	:	US
Telephone Number	:	503-742-5937
Fax Number	:	503-742-5304

Provider Business Practice Location Address
First Line	:	2051 KAEN RD
Second Line	:	SUITE 367
City	:	OREGON CITY
State	:	OR
Zip	:	97045-4035
Country	:	US
Telephone Number	:	503-742-5937
Fax Number	:	503-742-5304

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	07/31/2006
Last Update Date	:	10/01/2009

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