1255630935 NPI number — MS. TOSHIE MINHAE CHEELEY LCSW

Table of content: MS. TOSHIE MINHAE CHEELEY LCSW (NPI 1255630935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1255630935 NPI number — MS. TOSHIE MINHAE CHEELEY LCSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHEELEY
Provider First Name:
TOSHIE
Provider Middle Name:
MINHAE
Provider Name Prefix Text:
MS.
Provider Name Suffix Text:
Provider Credential Text:
LCSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CHEELEY
Provider Other First Name:
MINHAE
Provider Other Middle Name:
TOSHIE
Provider Other Name Prefix Text:
MS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LCSW
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1255630935
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
09/01/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3125 MYERS STREET
Provider Second Line Business Mailing Address:
BLDG 3
Provider Business Mailing Address City Name:
RIVERSIDE
Provider Business Mailing Address State Name:
CA
Provider Business Mailing Address Postal Code:
92503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
951-358-5810
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3125 MYERS STREET
Provider Second Line Business Practice Location Address:
BLDG 3
Provider Business Practice Location Address City Name:
RIVERSIDE
Provider Business Practice Location Address State Name:
CA
Provider Business Practice Location Address Postal Code:
92503
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
951-358-5810
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/21/2011

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 1041C0700X , with the licence number:  LCS 27769 , registered in the state of CA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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