Provider Demographics
NPI:1962634782
Name:STOCKSTILL, CHERRI LYNNE (LPC, NCC)
Entity type:Individual
Prefix:
First Name:CHERRI
Middle Name:LYNNE
Last Name:STOCKSTILL
Suffix:
Gender:F
Credentials:LPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 1165
Mailing Address - Street 2:
Mailing Address - City:NIXA
Mailing Address - State:MO
Mailing Address - Zip Code:65714-1165
Mailing Address - Country:US
Mailing Address - Phone:417-597-3446
Mailing Address - Fax:
Practice Address - Street 1:1722 SOUTH GLENSTONE AVE, SUITE J-11
Practice Address - Street 2:
Practice Address - City:SPRINGFIELD
Practice Address - State:MO
Practice Address - Zip Code:65804
Practice Address - Country:US
Practice Address - Phone:417-597-3446
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-08-12
Last Update Date:2018-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO200904321101YP2500X
MO2009024321101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MO1470167Medicaid
MO1470183Medicaid
MO1770855306OtherREIGNHEART COUNSELING
MO1962634782Medicaid