Provider Demographics
NPI:1194402156
Name:CHERRY HILLS NEUROPSYCHOLOGY LLC
Entity type:Organization
Organization Name:CHERRY HILLS NEUROPSYCHOLOGY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER, NEUROPSYCHOLOGIST
Authorized Official - Prefix:
Authorized Official - First Name:ASHLEY
Authorized Official - Middle Name:
Authorized Official - Last Name:WATTS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:505-620-5560
Mailing Address - Street 1:PO BOX 13883
Mailing Address - Street 2:
Mailing Address - City:SALEM
Mailing Address - State:OR
Mailing Address - Zip Code:97309-1883
Mailing Address - Country:US
Mailing Address - Phone:971-301-4771
Mailing Address - Fax:
Practice Address - Street 1:698 12TH STREET SE
Practice Address - Street 2:SUITE 240 OFFICE 6
Practice Address - City:SALEM
Practice Address - State:OR
Practice Address - Zip Code:97301
Practice Address - Country:US
Practice Address - Phone:971-301-4771
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-30
Last Update Date:2023-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty