Provider Demographics
NPI:1558782219
Name:MATA, SHERRI (LPC)
Entity Type:Individual
Prefix:
First Name:SHERRI
Middle Name:
Last Name:MATA
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 1:500 SUNFISH CT
Mailing Address - Street 2:
Mailing Address - City:CROWLEY
Mailing Address - State:TX
Mailing Address - Zip Code:76036-3989
Mailing Address - Country:US
Mailing Address - Phone:817-312-6606
Mailing Address - Fax:
Practice Address - Street 1:500 SUNFISH CT
Practice Address - Street 2:
Practice Address - City:CROWLEY
Practice Address - State:TX
Practice Address - Zip Code:76036-3989
Practice Address - Country:US
Practice Address - Phone:817-312-6606
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2013-12-26
Last Update Date:2013-12-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX63081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional