Provider Demographics
NPI:1851409296
Name:GAY, CHERYL LYNN (LCSW)
Entity Type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:LYNN
Last Name:GAY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 817
Mailing Address - Street 2:
Mailing Address - City:KENDALLVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46755-0817
Mailing Address - Country:US
Mailing Address - Phone:260-347-2453
Mailing Address - Fax:260-347-2456
Practice Address - Street 1:200 HOOSIER DR
Practice Address - Street 2:SUITE E
Practice Address - City:ANGOLA
Practice Address - State:IN
Practice Address - Zip Code:46703-9345
Practice Address - Country:US
Practice Address - Phone:260-665-9494
Practice Address - Fax:260-665-9496
Is Sole Proprietor?:No
Enumeration Date:2006-08-27
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34004806A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
INPENDINGMedicare ID - Type UnspecifiedPROVIDER NUMBER