1457888778 NPI number — MONA KAY CHERRYHOLMES MSW, LMSW

Table of content: MONA KAY CHERRYHOLMES MSW, LMSW (NPI 1457888778)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1457888778 NPI number — MONA KAY CHERRYHOLMES MSW, LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
CHERRYHOLMES
Provider First Name:
MONA
Provider Middle Name:
KAY
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MSW, LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1457888778
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
07/21/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1855 N WEBB RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WICHITA
Provider Business Mailing Address State Name:
KS
Provider Business Mailing Address Postal Code:
67206-3413
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
316-636-2888
Provider Business Mailing Address Fax Number:
316-927-3019

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1223 N. ROCK RD
Provider Second Line Business Practice Location Address:
BLDG A. SUITE 100
Provider Business Practice Location Address City Name:
WICHITA
Provider Business Practice Location Address State Name:
KS
Provider Business Practice Location Address Postal Code:
67206
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
316-636-2888
Provider Business Practice Location Address Fax Number:
316-927-3019
Provider Enumeration Date:
05/17/2017

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: 104100000X , with the licence number:  10357 , registered in the state of KS ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





Copyright © 2007-2025 www.npivalidator.com