Provider Demographics
NPI:1053679761
Name:PUGH, CHERYL LYNN (PSYD)
Entity Type:Individual
Prefix:DR
First Name:CHERYL
Middle Name:LYNN
Last Name:PUGH
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5301 W WASHINGTON BLVD FL 2
Mailing Address - Street 2:
Mailing Address - City:CHICAGO
Mailing Address - State:IL
Mailing Address - Zip Code:60644-3496
Mailing Address - Country:US
Mailing Address - Phone:312-316-7223
Mailing Address - Fax:
Practice Address - Street 1:5301 W WASHINGTON BLVD FL 2
Practice Address - Street 2:
Practice Address - City:CHICAGO
Practice Address - State:IL
Practice Address - Zip Code:60644-3496
Practice Address - Country:US
Practice Address - Phone:312-316-7223
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-05-01
Last Update Date:2012-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IL26802101YA0400X
IL180008113101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)