Provider Demographics
NPI:1619379740
Name:SHERRILL, RACHEL BADEN (PHD)
Entity Type:Individual
Prefix:DR
First Name:RACHEL
Middle Name:BADEN
Last Name:SHERRILL
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:RACHEL
Other - Middle Name:ELIZABETH
Other - Last Name:BADEN
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:PO BOX 8033
Mailing Address - Street 2:
Mailing Address - City:COLUMBUS
Mailing Address - State:MS
Mailing Address - Zip Code:39705-0007
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:815 2ND AVE N
Practice Address - Street 2:
Practice Address - City:COLUMBUS
Practice Address - State:MS
Practice Address - Zip Code:39701-4703
Practice Address - Country:US
Practice Address - Phone:662-370-1082
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-09-19
Last Update Date:2022-05-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NJ35SI00595300103T00000X
PAPS017574103TC0700X
MS611096103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical