Provider Demographics
NPI:1821276270
Name:TYGER, SHERRY T (LCSW)
Entity Type:Individual
Prefix:
First Name:SHERRY
Middle Name:T
Last Name:TYGER
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:TYGER
Other - Last Name:GOODELL
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LCSW
Mailing Address - Street 1:380 SUWANNEE TRAIL ST
Mailing Address - Street 2:
Mailing Address - City:BOWLING GREEN
Mailing Address - State:KY
Mailing Address - Zip Code:42103-7956
Mailing Address - Country:US
Mailing Address - Phone:270-901-5000
Mailing Address - Fax:270-842-5268
Practice Address - Street 1:501 CHESTNUT ST
Practice Address - Street 2:
Practice Address - City:BOWLING GREEN
Practice Address - State:KY
Practice Address - Zip Code:42101
Practice Address - Country:US
Practice Address - Phone:270-901-5712
Practice Address - Fax:270-781-8987
Is Sole Proprietor?:No
Enumeration Date:2008-02-07
Last Update Date:2017-12-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KY37231041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
KY7100333490Medicaid