Provider Demographics
NPI:1881105518
Name:WULF, CHERRY
Entity type:Individual
Prefix:
First Name:CHERRY
Middle Name:
Last Name:WULF
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1008 VINE ST
Mailing Address - Street 2:
Mailing Address - City:ARAPAHOE
Mailing Address - State:NE
Mailing Address - Zip Code:68922-5552
Mailing Address - Country:US
Mailing Address - Phone:308-655-1097
Mailing Address - Fax:
Practice Address - Street 1:701 5TH STREET
Practice Address - Street 2:
Practice Address - City:ARAPAHOE
Practice Address - State:NE
Practice Address - Zip Code:68922-0618
Practice Address - Country:US
Practice Address - Phone:308-655-0014
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2017-10-20
Last Update Date:2024-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE5417101YM0800X
NE2559101YM0800X
NE101YM0800X
NE2974101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty