Provider Demographics
NPI:1598268948
Name:BUNN, SHERYL (REV, AA,BS PSY, CC)
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:
Last Name:BUNN
Suffix:
Gender:F
Credentials:REV, AA,BS PSY, CC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4411 BUCHANAN LOOP RD
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75501-9508
Mailing Address - Country:US
Mailing Address - Phone:512-718-6473
Mailing Address - Fax:
Practice Address - Street 1:4411 BUCHANAN LOOP RD
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75501-9508
Practice Address - Country:US
Practice Address - Phone:512-718-6473
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-03-12
Last Update Date:2018-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral