Provider Demographics
NPI:1992085773
Name:MCCORMACK FRESH, CHERI (LCPC)
Entity type:Individual
Prefix:
First Name:CHERI
Middle Name:
Last Name:MCCORMACK FRESH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1042 W. MILL AVE.
Mailing Address - Street 2:SUITE 205
Mailing Address - City:COEUR D ALENE
Mailing Address - State:ID
Mailing Address - Zip Code:83814
Mailing Address - Country:US
Mailing Address - Phone:208-661-1495
Mailing Address - Fax:
Practice Address - Street 1:2005 N IRONWOOD PKWY STE 226
Practice Address - Street 2:
Practice Address - City:COEUR D ALENE
Practice Address - State:ID
Practice Address - Zip Code:83814-2680
Practice Address - Country:US
Practice Address - Phone:208-661-1495
Practice Address - Fax:208-545-5222
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-24
Last Update Date:2023-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-5190101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health