Provider Demographics
NPI:1558802132
Name:KASHALE, GARY (LPC)
Entity Type:Individual
Prefix:
First Name:GARY
Middle Name:
Last Name:KASHALE
Suffix:
Gender:M
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6209 S PINNACLE PL STE 102
Mailing Address - Street 2:
Mailing Address - City:SIOUX FALLS
Mailing Address - State:SD
Mailing Address - Zip Code:57108-3011
Mailing Address - Country:US
Mailing Address - Phone:605-789-7464
Mailing Address - Fax:605-789-7486
Practice Address - Street 1:6209 S PINNACLE PL STE 102
Practice Address - Street 2:
Practice Address - City:SIOUX FALLS
Practice Address - State:SD
Practice Address - Zip Code:57108-3011
Practice Address - Country:US
Practice Address - Phone:605-789-7464
Practice Address - Fax:605-789-7486
Is Sole Proprietor?:No
Enumeration Date:2017-03-15
Last Update Date:2017-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SDLPC20252101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional