Provider Demographics
NPI:1194777896
Name:POLLY, CHERYL (L P C PC)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:POLLY
Suffix:
Gender:F
Credentials:L P C PC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:909 8TH ST
Mailing Address - Street 2:STE 300
Mailing Address - City:WICHITA FALLS
Mailing Address - State:TX
Mailing Address - Zip Code:76301-6817
Mailing Address - Country:US
Mailing Address - Phone:940-767-2914
Mailing Address - Fax:940-767-2914
Practice Address - Street 1:909 8TH ST
Practice Address - Street 2:STE 300
Practice Address - City:WICHITA FALLS
Practice Address - State:TX
Practice Address - Zip Code:76301-6820
Practice Address - Country:US
Practice Address - Phone:940-767-2914
Practice Address - Fax:866-838-5630
Is Sole Proprietor?:No
Enumeration Date:2006-05-17
Last Update Date:2023-11-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13054101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX026846801Medicaid