MEDICARE: MS. CHERYL MCCAULEY

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

General Provider Information

NPI Number	:	1578667903
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	MS. CHERYL MCCAULEY

Provider Business Mailing Address
First Line	:	115 ROCKWOOD LN
Second Line	:
City	:	HAZARD
State	:	KY
Zip	:	41701-9415
Country	:	US
Telephone Number	:	606-436-5761
Fax Number	:	606-436-5797

Provider Business Practice Location Address
First Line	:	HWY 11 SOUTH
Second Line	:
City	:	BOONEVILLE
State	:	KY
Zip	:	41314
Country	:	US
Telephone Number	:	606-593-6323
Fax Number	:	606-436-5797

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

Provider Enumeration Date	:	09/07/2006
Last Update Date	:	07/08/2007

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