Provider Demographics
NPI:1144685579
Name:GARY-CHEIRS, SHELLIE (LPCC)
Entity type:Individual
Prefix:MS
First Name:SHELLIE
Middle Name:
Last Name:GARY-CHEIRS
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4730 HANSON RD
Mailing Address - Street 2:
Mailing Address - City:MADISONVILLE
Mailing Address - State:KY
Mailing Address - Zip Code:42431-6154
Mailing Address - Country:US
Mailing Address - Phone:270-681-2273
Mailing Address - Fax:270-208-4141
Practice Address - Street 1:108 SOUTH MAIN STREET
Practice Address - Street 2:SUITE 104
Practice Address - City:MADISONVILLE
Practice Address - State:KY
Practice Address - Zip Code:42431
Practice Address - Country:US
Practice Address - Phone:270-681-2273
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-12-30
Last Update Date:2019-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KYLPCPCC00223771101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional