Provider Demographics
NPI:1083018683
Name:SHERRILL, SUSAN (MS QMHP)
Entity Type:Individual
Prefix:
First Name:SUSAN
Middle Name:
Last Name:SHERRILL
Suffix:
Gender:F
Credentials:MS QMHP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:24041 HIGHWAY 140
Mailing Address - Street 2:
Mailing Address - City:EAGLE POINT
Mailing Address - State:OR
Mailing Address - Zip Code:97524-5552
Mailing Address - Country:US
Mailing Address - Phone:541-890-9714
Mailing Address - Fax:541-500-0910
Practice Address - Street 1:55 S 5TH ST STE P
Practice Address - Street 2:
Practice Address - City:CENTRAL POINT
Practice Address - State:OR
Practice Address - Zip Code:97502-2474
Practice Address - Country:US
Practice Address - Phone:541-890-9714
Practice Address - Fax:541-500-0910
Is Sole Proprietor?:Yes
Enumeration Date:2014-10-10
Last Update Date:2024-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORR3345101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health