Provider Demographics
NPI:1447378997
Name:SHERRON, ALICE (LPC)
Entity Type:Individual
Prefix:
First Name:ALICE
Middle Name:
Last Name:SHERRON
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:34077 SURREY LN
Mailing Address - Street 2:
Mailing Address - City:BUENA VISTA
Mailing Address - State:CO
Mailing Address - Zip Code:81211-8607
Mailing Address - Country:US
Mailing Address - Phone:719-395-9454
Mailing Address - Fax:719-395-9454
Practice Address - Street 1:111 E. STERLING AVE
Practice Address - Street 2:
Practice Address - City:BUENA VISTA
Practice Address - State:CO
Practice Address - Zip Code:81211
Practice Address - Country:US
Practice Address - Phone:719-395-9454
Practice Address - Fax:719-395-9454
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-26
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3804101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health