Provider Demographics
NPI:1063786713
Name:DIENZ, CHERRY (LADC)
Entity type:Individual
Prefix:MS
First Name:CHERRY
Middle Name:
Last Name:DIENZ
Suffix:
Gender:F
Credentials:LADC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2517 NW 62ND ST APT 44
Mailing Address - Street 2:
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-7184
Mailing Address - Country:US
Mailing Address - Phone:405-760-5291
Mailing Address - Fax:
Practice Address - Street 1:2517 NW 62ND ST APT 44
Practice Address - Street 2:
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-7184
Practice Address - Country:US
Practice Address - Phone:405-760-5291
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-02-27
Last Update Date:2021-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK1355101YA0400X
101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)