Provider Demographics
NPI:1669053831
Name:PANKEY, SANDRA GAIL (LMHCA)
Entity type:Individual
Prefix:
First Name:SANDRA
Middle Name:GAIL
Last Name:PANKEY
Suffix:
Gender:F
Credentials:LMHCA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7924 N CUZCO RD N
Mailing Address - Street 2:
Mailing Address - City:FRENCH LICK
Mailing Address - State:IN
Mailing Address - Zip Code:47432-9000
Mailing Address - Country:US
Mailing Address - Phone:812-791-2036
Mailing Address - Fax:
Practice Address - Street 1:4201 MANNHEIM RD STE G
Practice Address - Street 2:
Practice Address - City:JASPER
Practice Address - State:IN
Practice Address - Zip Code:47546-9617
Practice Address - Country:US
Practice Address - Phone:812-481-9988
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2021-04-19
Last Update Date:2021-04-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN88001305A101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health