Provider Demographics
NPI:1881020667
Name:GOURLEY, CINDY JEAN (MA, LMHC)
Entity Type:Individual
Prefix:
First Name:CINDY
Middle Name:JEAN
Last Name:GOURLEY
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 1:2755 GREENDALE DR
Mailing Address - Street 2:
Mailing Address - City:SARASOTA
Mailing Address - State:FL
Mailing Address - Zip Code:34232-3737
Mailing Address - Country:US
Mailing Address - Phone:941-323-8922
Mailing Address - Fax:
Practice Address - Street 1:2770 BROWNING ST
Practice Address - Street 2:
Practice Address - City:SARASOTA
Practice Address - State:FL
Practice Address - Zip Code:34237-7631
Practice Address - Country:US
Practice Address - Phone:941-323-8922
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-09-24
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
FL11054101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health