Provider Demographics
NPI:1578082434
Name:WISCONS, SHERA (LPC)
Entity Type:Individual
Prefix:
First Name:SHERA
Middle Name:
Last Name:WISCONS
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 1:316 WYNDEMERE DR
Mailing Address - Street 2:
Mailing Address - City:LAKE SAINT LOUIS
Mailing Address - State:MO
Mailing Address - Zip Code:63367-4223
Mailing Address - Country:US
Mailing Address - Phone:636-699-7738
Mailing Address - Fax:
Practice Address - Street 1:316 WYNDEMERE DR
Practice Address - Street 2:
Practice Address - City:LAKE SAINT LOUIS
Practice Address - State:MO
Practice Address - Zip Code:63367-4223
Practice Address - Country:US
Practice Address - Phone:636-699-7738
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2017-09-12
Last Update Date:2022-07-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
SC6348101YP2500X
MO2018036209101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional