Provider Demographics
NPI:1053380329
Name:MCINTOSH, CHERYLYN (LPC, LMFT)
Entity type:Individual
Prefix:MRS
First Name:CHERYLYN
Middle Name:
Last Name:MCINTOSH
Suffix:
Gender:F
Credentials:LPC, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:219 WILLIS RD
Mailing Address - Street 2:
Mailing Address - City:RAYVILLE
Mailing Address - State:LA
Mailing Address - Zip Code:71269-5835
Mailing Address - Country:US
Mailing Address - Phone:318-248-3884
Mailing Address - Fax:318-322-9213
Practice Address - Street 1:1900 LAMY LN
Practice Address - Street 2:SUITE O
Practice Address - City:MONROE
Practice Address - State:LA
Practice Address - Zip Code:71201-9207
Practice Address - Country:US
Practice Address - Phone:318-322-9523
Practice Address - Fax:318-322-9213
Is Sole Proprietor?:Not Answered
Enumeration Date:2006-03-17
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA2676101YM0800X
LA233106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Not Answered101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Not Answered106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist