MEDICARE: CHERYL L. CONFER LMHC

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	39000056A	IN

General Provider Information

NPI Number	:	1831170406
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	CHERYL L. CONFER LMHC

Provider Business Mailing Address
First Line	:	6530 CONSTITUTION DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1550
Country	:	US
Telephone Number	:	260-414-4809
Fax Number	:	260-459-0282

Provider Business Practice Location Address
First Line	:	6530 CONSTITUTION DR
Second Line	:
City	:	FORT WAYNE
State	:	IN
Zip	:	46804-1550
Country	:	US
Telephone Number	:	260-414-4809
Fax Number	:	260-459-0282

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

Provider Enumeration Date	:	11/09/2005
Last Update Date	:	07/08/2007

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