Individual ProviderCheryllyn LongoriaCounselorBehavioral Health & Social Service ProvidersPractice Address6171 W Charleston Blvd, Bldg 13, Las Vegas, NV 89146-1126(702) 486-6166PECOS EnrollmentBased on the most recent information from CMS, provider Cheryllyn Longoria does not have current enrollment records in PECOS.Part BMedicare Part BNot EnrolledHHAHome Health AgencyNot EnrolledDMEDurable Medical EquipmentNot EnrolledPMDPower Mobility DeviceNot EnrolledCMS last updated its PECOS records 2 days ago.Profile DetailsProvider ID1013277367Provider TypeIndividualFull NameLongoria, CheryllynTitleMrs.GenderFemaleSole ProprietorYesEnumeration Date5/21/2012Last Updated6/3/2013Contact InformationPractice LocationPractice Address6171 W Charleston Blvd, Bldg 13, Las Vegas, NV 89146-1126Phone(702) 486-6166FaxUnlisted FaxMailing LocationMailing Address6171 W Charleston Blvd, Bldg 13, Las Vegas, NV 89146-1126Phone(702) 486-6166FaxUnlisted FaxProvider TaxonomiesCodeDescriptionLicenseCode101YM0800XPrimaryDescriptionCounselorBehavioral Health & Social Service ProvidersLicenseUnlisted IssuerCode252Y00000XDescriptionEarly Intervention Provider AgencyAgenciesLicenseUnlisted Issuer