Provider Demographics
NPI:1154439057
Name:PACE, CHERYL RUTH (LPC)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:RUTH
Last Name:PACE
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1520 RICE RD
Mailing Address - Street 2:SUITE 200
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75703-3259
Mailing Address - Country:US
Mailing Address - Phone:903-581-6300
Mailing Address - Fax:903-581-0235
Practice Address - Street 1:1520 RICE RD
Practice Address - Street 2:SUITE 200
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75703-3259
Practice Address - Country:US
Practice Address - Phone:903-581-6300
Practice Address - Fax:903-581-0235
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-29
Last Update Date:2010-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX12998101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX095744102Medicaid
TX0015MXOtherBCBS
TX095744101Medicaid