Provider Demographics
NPI:1447357504
Name:ELAM, CHERYL (MFT)
Entity type:Individual
Prefix:
First Name:CHERYL
Middle Name:
Last Name:ELAM
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 790
Mailing Address - Street 2:
Mailing Address - City:ASHLAND
Mailing Address - State:KY
Mailing Address - Zip Code:41105-0790
Mailing Address - Country:US
Mailing Address - Phone:606-329-8588
Mailing Address - Fax:606-329-8195
Practice Address - Street 1:300 FOXGLOVE DR
Practice Address - Street 2:
Practice Address - City:MT STERLING
Practice Address - State:KY
Practice Address - Zip Code:40353-9769
Practice Address - Country:US
Practice Address - Phone:859-498-2135
Practice Address - Fax:859-498-7547
Is Sole Proprietor?:No
Enumeration Date:2006-09-20
Last Update Date:2014-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY0514106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
000000509976OtherANTHEM BCBS
11645494OtherCAQH
KY7100283050Medicaid
610661987OtherUNITED BEHAVIORAL HEALTH
610661987OtherHUMANA CHOICECARE
9971265OtherAETNA
610661987OtherHUMANA CHOICECARE