Provider Demographics
NPI:1104862333
Name:LATHAM, SHERRY ANN (PHD LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:ANN
Last Name:LATHAM
Suffix:
Gender:F
Credentials:PHD LPC
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:ANN
Other - Last Name:BURKE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:PO BOX 15276
Mailing Address - Street 2:
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78212-8476
Mailing Address - Country:US
Mailing Address - Phone:210-212-8285
Mailing Address - Fax:210-212-8229
Practice Address - Street 1:1017 N MAIN AVE
Practice Address - Street 2:SUITE 204
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78212-4723
Practice Address - Country:US
Practice Address - Phone:210-212-8285
Practice Address - Fax:210-212-8229
Is Sole Proprietor?:Yes
Enumeration Date:2006-06-22
Last Update Date:2008-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX01266101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX278850000OtherMAGELLAN HEALTH
TX4190LCOtherBLUE CROSS BLUE SHIELD
TX026240401Medicaid