Provider Demographics
NPI:1689783888
Name:BOLES, SHERYL (SHERRY) WHITMAN (LMHC)
Entity Type:Individual
Prefix:MS
First Name:SHERYL (SHERRY)
Middle Name:WHITMAN
Last Name:BOLES
Suffix:
Gender:F
Credentials:LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:PO BOX 1870
Mailing Address - Street 2:CROSSROADS COUNSELING CENTER
Mailing Address - City:FORT WALTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:32549-1870
Mailing Address - Country:US
Mailing Address - Phone:850-796-7200
Mailing Address - Fax:850-796-7251
Practice Address - Street 1:98 MIRACLE STRIP PKWY #205
Practice Address - Street 2:CROSSROADS COUNSELING CENTER
Practice Address - City:FORT WALTON BEACH
Practice Address - State:FL
Practice Address - Zip Code:32548
Practice Address - Country:US
Practice Address - Phone:850-796-7200
Practice Address - Fax:850-796-7251
Is Sole Proprietor?:Yes
Enumeration Date:2006-08-30
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLMH6737101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
FLZ9316OtherBCBS PROVIDER ID #