Provider Demographics
NPI:1073697611
Name:CHAMBLISS, SHERRY P (LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:P
Last Name:CHAMBLISS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3275 LIVE OAK RD
Mailing Address - Street 2:
Mailing Address - City:CUERO
Mailing Address - State:TX
Mailing Address - Zip Code:77954
Mailing Address - Country:US
Mailing Address - Phone:361-275-8057
Mailing Address - Fax:361-277-8298
Practice Address - Street 1:5606 N NAVARRO
Practice Address - Street 2:STE 200P
Practice Address - City:VICTORIA
Practice Address - State:TX
Practice Address - Zip Code:77901
Practice Address - Country:US
Practice Address - Phone:361-485-6645
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-10-24
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13510101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor