Provider Demographics
NPI:1164095196
Name:CHERRY, PAUL (LPC, LCDC)
Entity type:Individual
Prefix:
First Name:PAUL
Middle Name:
Last Name:CHERRY
Suffix:
Gender:M
Credentials:LPC, LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8708 CLOUDYWAY DR
Mailing Address - Street 2:
Mailing Address - City:FORT WORTH
Mailing Address - State:TX
Mailing Address - Zip Code:76123-1688
Mailing Address - Country:US
Mailing Address - Phone:717-433-1234
Mailing Address - Fax:
Practice Address - Street 1:3509 HULEN ST STE 107
Practice Address - Street 2:
Practice Address - City:FORT WORTH
Practice Address - State:TX
Practice Address - Zip Code:76107-6834
Practice Address - Country:US
Practice Address - Phone:817-382-7130
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-07-19
Last Update Date:2025-11-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15834101YA0400X
TX86376101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)