Provider Demographics
NPI:1689844474
Name:SHERROD, JACKIE A (LCDC)
Entity Type:Individual
Prefix:
First Name:JACKIE
Middle Name:A
Last Name:SHERROD
Suffix:
Gender:F
Credentials:LCDC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:118 W HEARD ST
Mailing Address - Street 2:
Mailing Address - City:CLEBURNE
Mailing Address - State:TX
Mailing Address - Zip Code:76033-3836
Mailing Address - Country:US
Mailing Address - Phone:817-645-5517
Mailing Address - Fax:817-645-5715
Practice Address - Street 1:118 W HEARD ST
Practice Address - Street 2:
Practice Address - City:CLEBURNE
Practice Address - State:TX
Practice Address - Zip Code:76033-3836
Practice Address - Country:US
Practice Address - Phone:817-645-5517
Practice Address - Fax:817-645-5715
Is Sole Proprietor?:Yes
Enumeration Date:2008-03-07
Last Update Date:2008-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX1797101YA0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)