Provider Demographics
NPI:1962496406
Name:MANN, CHERYL LEE (LPC LCSW)
Entity type:Individual
Prefix:MRS
First Name:CHERYL
Middle Name:LEE
Last Name:MANN
Suffix:
Gender:F
Credentials:LPC LCSW
Other - Prefix:MISS
Other - First Name:CHERYL
Other - Middle Name:LEE
Other - Last Name:MCCORMICK
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:11004 E 40 HWY
Mailing Address - Street 2:#139
Mailing Address - City:INDEPENDENCE
Mailing Address - State:MO
Mailing Address - Zip Code:64055-6023
Mailing Address - Country:US
Mailing Address - Phone:816-989-2149
Mailing Address - Fax:816-356-4955
Practice Address - Street 1:11004 E 40 HWY
Practice Address - Street 2:#139
Practice Address - City:INDEPENDENCE
Practice Address - State:MO
Practice Address - Zip Code:64055-6023
Practice Address - Country:US
Practice Address - Phone:816-989-2149
Practice Address - Fax:816-356-4955
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-09-09
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MOCS000807101Y00000X
MOSW001784104100000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101Y00000XBehavioral Health & Social Service ProvidersCounselor
Not Answered104100000XBehavioral Health & Social Service ProvidersSocial Worker