Provider Demographics
NPI:1417022047
Name:SIMS BEACH, SHERRY DAWN (LCPC)
Entity Type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:DAWN
Last Name:SIMS BEACH
Suffix:
Gender:F
Credentials:LCPC
Other - Prefix:MS
Other - First Name:SHERRY
Other - Middle Name:SIMS
Other - Last Name:BEACH
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:LCPC
Mailing Address - Street 1:321 E MAIN ST
Mailing Address - Street 2:SUITE 311
Mailing Address - City:BOZEMAN
Mailing Address - State:MT
Mailing Address - Zip Code:59715-6241
Mailing Address - Country:US
Mailing Address - Phone:406-587-5987
Mailing Address - Fax:406-586-8749
Practice Address - Street 1:321 E MAIN ST
Practice Address - Street 2:SUITE 311
Practice Address - City:BOZEMAN
Practice Address - State:MT
Practice Address - Zip Code:59715-6241
Practice Address - Country:US
Practice Address - Phone:406-587-5987
Practice Address - Fax:406-586-8749
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-21
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MT525101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MT75136OtherBCBS OF MT PIN
MT0255515Medicaid