Provider Demographics
NPI:1851447015
Name:GOLLY, SHERI L (LCSW)
Entity Type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:L
Last Name:GOLLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 N MAIN ST
Mailing Address - Street 2:SUITE 200
Mailing Address - City:GRAPEVINE
Mailing Address - State:TX
Mailing Address - Zip Code:76051-9213
Mailing Address - Country:US
Mailing Address - Phone:817-886-5777
Mailing Address - Fax:817-421-1950
Practice Address - Street 1:621 N MAIN ST
Practice Address - Street 2:SUITE 200
Practice Address - City:GRAPEVINE
Practice Address - State:TX
Practice Address - Zip Code:76051-9213
Practice Address - Country:US
Practice Address - Phone:817-886-5777
Practice Address - Fax:817-421-1950
Is Sole Proprietor?:Yes
Enumeration Date:2007-01-28
Last Update Date:2010-04-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX160441041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063955102Medicaid