Provider Demographics
NPI:1104063130
Name:ALLEN, CHERYL MARYE (MS, LPCC-S)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:MARYE
Last Name:ALLEN
Suffix:
Gender:F
Credentials:MS, LPCC-S
Other - Prefix:MS
Other - First Name:CHERYL
Other - Middle Name:MARYE
Other - Last Name:BAKER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:MS, LPCC
Mailing Address - Street 1:1205 RESTON CT
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-2066
Mailing Address - Country:US
Mailing Address - Phone:614-870-6670
Mailing Address - Fax:614-870-6855
Practice Address - Street 1:1535 GEORGESVILLE RD
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:OH
Practice Address - Zip Code:43228
Practice Address - Country:US
Practice Address - Phone:614-870-6670
Practice Address - Fax:614-878-6855
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-13
Last Update Date:2018-08-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN11072541101YM0800X
TNLPC0000004166101YP2500X
OHE0500464101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
OH3083478Medicaid
TN11072541OtherEXECUTIVE CERTIFICATE
OHE0500464OtherLICENSURE
TNLPC0000004166OtherLICENSURE