Provider Demographics
NPI:1760500805
Name:LEACH, CHERLYN (MA,LPC)
Entity Type:Individual
Prefix:MS
First Name:CHERLYN
Middle Name:
Last Name:LEACH
Suffix:
Gender:F
Credentials:MA,LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:500 E 9TH STREET
Mailing Address - Street 2:PO BOX 662
Mailing Address - City:WINNER
Mailing Address - State:SD
Mailing Address - Zip Code:57580-0622
Mailing Address - Country:US
Mailing Address - Phone:605-842-1465
Mailing Address - Fax:605-842-2366
Practice Address - Street 1:500 E 9TH STREET
Practice Address - Street 2:
Practice Address - City:WINNER
Practice Address - State:SD
Practice Address - Zip Code:57580-0622
Practice Address - Country:US
Practice Address - Phone:605-842-1465
Practice Address - Fax:605-842-2366
Is Sole Proprietor?:No
Enumeration Date:2007-03-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SD601101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health