Provider Demographics
NPI:1689050643
Name:BRAGG, SHERYL LYNN (CP 60116516)
Entity Type:Individual
Prefix:MISS
First Name:SHERYL
Middle Name:LYNN
Last Name:BRAGG
Suffix:
Gender:F
Credentials:CP 60116516
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1511 CENTER ST
Mailing Address - Street 2:
Mailing Address - City:SHELTON
Mailing Address - State:WA
Mailing Address - Zip Code:98584-1105
Mailing Address - Country:US
Mailing Address - Phone:360-888-8337
Mailing Address - Fax:
Practice Address - Street 1:1511 CENTER ST
Practice Address - Street 2:
Practice Address - City:SHELTON
Practice Address - State:WA
Practice Address - Zip Code:98584-1105
Practice Address - Country:US
Practice Address - Phone:360-888-8337
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2015-07-31
Last Update Date:2015-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WACP 60116516101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor