Provider Demographics
NPI:1457630006
Name:CLINTON, SHERRY DIANA
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:DIANA
Last Name:CLINTON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1445 AMERICAN PACIFIC DR
Mailing Address - Street 2:#110-301
Mailing Address - City:HENDERSON
Mailing Address - State:NV
Mailing Address - Zip Code:89074-7402
Mailing Address - Country:US
Mailing Address - Phone:702-927-3274
Mailing Address - Fax:
Practice Address - Street 1:1445 AMERICAN PACIFIC DR
Practice Address - Street 2:#110-301
Practice Address - City:HENDERSON
Practice Address - State:NV
Practice Address - Zip Code:89074-7402
Practice Address - Country:US
Practice Address - Phone:702-927-3274
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-08-15
Last Update Date:2011-08-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health