Healthcare Provider Details

I. General information

NPI: 1407771546
Provider Name (Legal Business Name): CHERI LYNN GAMBLE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/10/2026
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5675 FAIRVIEW ST
STEVENSVILLE MI
49127-1033
US

IV. Provider business mailing address

721 S 15TH ST
NILES MI
49120-3843
US

V. Phone/Fax

Practice location:
  • Phone: 269-429-7727
  • Fax:
Mailing address:
  • Phone: 269-429-7727
  • Fax: 269-429-5754

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number6401226449
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: