Provider Demographics
NPI:1871578708
Name:WAHLGREN, CHERYLN J (LMHP)
Entity type:Individual
Prefix:MRS
First Name:CHERYLN
Middle Name:J
Last Name:WAHLGREN
Suffix:
Gender:F
Credentials:LMHP
Other - Prefix:
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Mailing Address - Street 1:221 W 2ND ST
Mailing Address - Street 2:STE 105
Mailing Address - City:NORTH PLATTE
Mailing Address - State:NE
Mailing Address - Zip Code:69101-3905
Mailing Address - Country:US
Mailing Address - Phone:308-534-3351
Mailing Address - Fax:308-696-3801
Practice Address - Street 1:221 W 2ND ST
Practice Address - Street 2:STE 105
Practice Address - City:NORTH PLATTE
Practice Address - State:NE
Practice Address - Zip Code:69101-3905
Practice Address - Country:US
Practice Address - Phone:308-534-3351
Practice Address - Fax:308-696-3801
Is Sole Proprietor?:Not Answered
Enumeration Date:2005-12-14
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
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Provider Licenses
StateLicense IDTaxonomies
NE2044101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health