Provider Demographics
NPI:1497378871
Name:OTTO, SHERRY DAYNE (MED, LPC)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:DAYNE
Last Name:OTTO
Suffix:
Gender:F
Credentials:MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4924 N STATE HIGHWAY 45 E
Mailing Address - Street 2:
Mailing Address - City:PFLUGERVILLE
Mailing Address - State:TX
Mailing Address - Zip Code:78660-7500
Mailing Address - Country:US
Mailing Address - Phone:512-796-6469
Mailing Address - Fax:
Practice Address - Street 1:1000 HERITAGE CENTER CIR STE 158
Practice Address - Street 2:
Practice Address - City:ROUND ROCK
Practice Address - State:TX
Practice Address - Zip Code:78664-4463
Practice Address - Country:US
Practice Address - Phone:512-796-6469
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-05-20
Last Update Date:2020-05-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX77020101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health