Provider Demographics
NPI:1689896342
Name:GAGE, CHERISSE R (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:CHERISSE
Middle Name:R
Last Name:GAGE
Suffix:
Gender:F
Credentials:MA, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1522 CONSTITUTION BLVD
Mailing Address - Street 2:#391
Mailing Address - City:SALINAS
Mailing Address - State:CA
Mailing Address - Zip Code:93905-3803
Mailing Address - Country:US
Mailing Address - Phone:214-608-6406
Mailing Address - Fax:
Practice Address - Street 1:17782 MORO RD
Practice Address - Street 2:
Practice Address - City:PRUNEDALE
Practice Address - State:CA
Practice Address - Zip Code:93907-8961
Practice Address - Country:US
Practice Address - Phone:408-763-9546
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2007-05-03
Last Update Date:2017-03-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CALPC2365102L00000X
FLMH11313101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes102L00000XBehavioral Health & Social Service ProvidersPsychoanalyst
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health