Provider Demographics
NPI:1174059729
Name:JEPHUNNEH, CHERUBIM
Entity type:Individual
Prefix:
First Name:CHERUBIM
Middle Name:
Last Name:JEPHUNNEH
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 1:249 NC-54 STE 320
Mailing Address - Street 2:
Mailing Address - City:DURHAM
Mailing Address - State:NC
Mailing Address - Zip Code:27713-2490
Mailing Address - Country:US
Mailing Address - Phone:919-907-3334
Mailing Address - Fax:
Practice Address - Street 1:1 S CHURCH AVE STE 1200
Practice Address - Street 2:
Practice Address - City:TUCSON
Practice Address - State:AZ
Practice Address - Zip Code:85701-1601
Practice Address - Country:US
Practice Address - Phone:888-938-9393
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-05-02
Last Update Date:2023-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
106S00000X
NCP0187611041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106S00000XBehavioral Health & Social Service ProvidersBehavior Technician