Provider Demographics
NPI:1497450753
Name:SHERMAN, TERA RAE
Entity Type:Individual
Prefix:
First Name:TERA
Middle Name:RAE
Last Name:SHERMAN
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 1:17470 STERLING LAKE DR
Mailing Address - Street 2:
Mailing Address - City:FORT MYERS
Mailing Address - State:FL
Mailing Address - Zip Code:33967-7222
Mailing Address - Country:US
Mailing Address - Phone:812-320-0866
Mailing Address - Fax:
Practice Address - Street 1:17595 S TAMIAMI TRL STE 111
Practice Address - Street 2:
Practice Address - City:FORT MYERS
Practice Address - State:FL
Practice Address - Zip Code:33908-4500
Practice Address - Country:US
Practice Address - Phone:812-320-0866
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-04-04
Last Update Date:2023-04-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FL1085800101YS0200X
FLIMH23501101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YS0200XBehavioral Health & Social Service ProvidersCounselorSchool