Provider Demographics
NPI:1477009629
Name:SHERIDAN-ROBERSON, PRISCILLA (LMFT-A)
Entity Type:Individual
Prefix:
First Name:PRISCILLA
Middle Name:
Last Name:SHERIDAN-ROBERSON
Suffix:
Gender:F
Credentials:LMFT-A
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16414 SAN PEDRO AVE
Mailing Address - Street 2:STE. 710
Mailing Address - City:SAN ANTONIO
Mailing Address - State:TX
Mailing Address - Zip Code:78232
Mailing Address - Country:US
Mailing Address - Phone:210-248-9622
Mailing Address - Fax:
Practice Address - Street 1:16414 SAN PEDRO AVE
Practice Address - Street 2:STE. 710
Practice Address - City:SAN ANTONIO
Practice Address - State:TX
Practice Address - Zip Code:78232-2277
Practice Address - Country:US
Practice Address - Phone:210-248-9622
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-08-28
Last Update Date:2016-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX202790106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist