Provider Demographics
NPI:1245393792
Name:GILL, SHERRY MALCOMB (MA)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:MALCOMB
Last Name:GILL
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:14100 SOUTHWEST FWY
Mailing Address - Street 2:SUITE 240
Mailing Address - City:SUGAR LAND
Mailing Address - State:TX
Mailing Address - Zip Code:77478-3466
Mailing Address - Country:US
Mailing Address - Phone:281-491-4455
Mailing Address - Fax:281-491-3565
Practice Address - Street 1:14100 SOUTHWEST FWY
Practice Address - Street 2:SUITE 240
Practice Address - City:SUGAR LAND
Practice Address - State:TX
Practice Address - Zip Code:77478-3466
Practice Address - Country:US
Practice Address - Phone:281-491-4455
Practice Address - Fax:281-491-3565
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-18
Last Update Date:2012-06-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX9829101YM0800X
TX3491106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health