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NPI Code Detail

MEDICARE: MS. CHERYL A VANCE MA, LMFT

MEDICARE: MS. CHERYL A VANCE MA, LMFT
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1106H00000XMarriage & Family Therapist35001739AIN

General Provider Information

NPI Number : 1033407440
Entity Type Code : Individual
Provider Name (Legal Business Name) : MS. CHERYL A VANCE MA, LMFT
Provider Business Mailing Address
First Line : 9319 N BAYFIELD DR
Second Line :
City : MC CORDSVILLE
State : IN
Zip : 46055-9254
Country : US
Telephone Number : 317-514-0491
Fax Number :
Provider Business Practice Location Address
First Line : 7425 E 86TH ST
Second Line :
City : INDIANAPOLIS
State : IN
Zip : 46256-1207
Country : US
Telephone Number : 317-474-6448
Fax Number : 317-468-9905
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 07/19/2011
Last Update Date : 07/19/2011

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