Provider Demographics
NPI:1558764175
Name:GORRELL, CHERYL ANN (LPC, LCPC)
Entity Type:Individual
Prefix:
First Name:CHERYL
Middle Name:ANN
Last Name:GORRELL
Suffix:
Gender:F
Credentials:LPC, LCPC
Other - Prefix:
Other - First Name:ANNIE.
Other - Middle Name:
Other - Last Name:GORRELL
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LPC, LCPC
Mailing Address - Street 1:15050 W 138TH ST UNIT 4017
Mailing Address - Street 2:
Mailing Address - City:OLATHE
Mailing Address - State:KS
Mailing Address - Zip Code:66063-5476
Mailing Address - Country:US
Mailing Address - Phone:913-901-7897
Mailing Address - Fax:
Practice Address - Street 1:18719 W 163RD TERRACE
Practice Address - Street 2:
Practice Address - City:OLATHE
Practice Address - State:KS
Practice Address - Zip Code:66062
Practice Address - Country:US
Practice Address - Phone:913-901-7897
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-28
Last Update Date:2022-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS02975101YP2500X
MO2013024555101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional