Provider Demographics
NPI:1124188016
Name:PATTON, SHERRY BROKUS (MA LPC)
Entity Type:Individual
Prefix:MRS
First Name:SHERRY
Middle Name:BROKUS
Last Name:PATTON
Suffix:
Gender:F
Credentials:MA LPC
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:ANTONETTE
Other - Last Name:BROKUS
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:PO BOX 27491
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78755-2513
Mailing Address - Country:US
Mailing Address - Phone:512-469-9005
Mailing Address - Fax:572-322-9690
Practice Address - Street 1:1300 WEST LYNN
Practice Address - Street 2:SUITE 207
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78703-3877
Practice Address - Country:US
Practice Address - Phone:512-469-9005
Practice Address - Fax:512-322-9690
Is Sole Proprietor?:No
Enumeration Date:2006-12-11
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX13839101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX3372LCOtherBLUE CROSS BLUE SHIELD TX