Provider Demographics
NPI:1134466030
Name:DAVIS, SHERRILL TAREN (LCDC-I 37787)
Entity Type:Individual
Prefix:MRS
First Name:SHERRILL
Middle Name:TAREN
Last Name:DAVIS
Suffix:
Gender:F
Credentials:LCDC-I 37787
Other - Prefix:
Other - First Name:SHERRILL
Other - Middle Name:TAREN
Other - Last Name:JACKSON
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PCCI2441
Mailing Address - Street 1:4107 ACORN LN
Mailing Address - Street 2:
Mailing Address - City:PORTER
Mailing Address - State:TX
Mailing Address - Zip Code:77365-9611
Mailing Address - Country:US
Mailing Address - Phone:281-608-7600
Mailing Address - Fax:281-608-7602
Practice Address - Street 1:4107 ACORN LN
Practice Address - Street 2:
Practice Address - City:PORTER
Practice Address - State:TX
Practice Address - Zip Code:77365-9611
Practice Address - Country:US
Practice Address - Phone:281-608-7600
Practice Address - Fax:281-608-7602
Is Sole Proprietor?:No
Enumeration Date:2013-01-11
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TX37787101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health