Provider Demographics
NPI:1619023058
Name:DESSELLE, SHERRY K (PHD)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:K
Last Name:DESSELLE
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:7424 PICARDY AVE
Mailing Address - Street 2:
Mailing Address - City:BATON ROUGE
Mailing Address - State:LA
Mailing Address - Zip Code:70808-4331
Mailing Address - Country:US
Mailing Address - Phone:225-588-6348
Mailing Address - Fax:866-438-8180
Practice Address - Street 1:7424 PICARDY AVE
Practice Address - Street 2:
Practice Address - City:BATON ROUGE
Practice Address - State:LA
Practice Address - Zip Code:70808-4331
Practice Address - Country:US
Practice Address - Phone:225-588-6348
Practice Address - Fax:866-438-8180
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-26
Last Update Date:2010-09-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LA1112103TC1900X
TX33201103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling