Provider Demographics
NPI:1033407440
Name:VANCE, CHERYL A (MA, LMFT)
Entity type:Individual
Prefix:MS
First Name:CHERYL
Middle Name:A
Last Name:VANCE
Suffix:
Gender:F
Credentials:MA, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9319 N BAYFIELD DR
Mailing Address - Street 2:
Mailing Address - City:MC CORDSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:46055-9254
Mailing Address - Country:US
Mailing Address - Phone:317-514-0491
Mailing Address - Fax:
Practice Address - Street 1:7425 E 86TH ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46256-1207
Practice Address - Country:US
Practice Address - Phone:317-474-6448
Practice Address - Fax:317-468-9905
Is Sole Proprietor?:Yes
Enumeration Date:2011-07-19
Last Update Date:2011-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN35001739A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist