MEDICARE: KELLY MARIE CASH LCSW

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
1	101YM0800X	Mental Health Counselor	3400596A	IN

General Provider Information

NPI Number	:	1255062154
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	KELLY MARIE CASH LCSW

Provider Business Mailing Address
First Line	:	9378 GERMAN RIDGE RD
Second Line	:
City	:	DERBY
State	:	IN
Zip	:	47525-9526
Country	:	US
Telephone Number	:	812-719-9418
Fax Number	:

Provider Business Practice Location Address
First Line	:	9378 GERMAN RIDGE RD
Second Line	:
City	:	DERBY
State	:	IN
Zip	:	47525-9526
Country	:	US
Telephone Number	:	812-719-9418
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/21/2022
Last Update Date	:	06/21/2022

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