Provider Demographics
NPI:1982229860
Name:RILEY, SHERITA (BHT)
Entity Type:Individual
Prefix:
First Name:SHERITA
Middle Name:
Last Name:RILEY
Suffix:
Gender:F
Credentials:BHT
Other - Prefix:
Other - First Name:SHERITA
Other - Middle Name:
Other - Last Name:RILEY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:
Mailing Address - Street 1:4213 S 81ST DR
Mailing Address - Street 2:
Mailing Address - City:PHOENIX
Mailing Address - State:AZ
Mailing Address - Zip Code:85043-1615
Mailing Address - Country:US
Mailing Address - Phone:860-778-2537
Mailing Address - Fax:
Practice Address - Street 1:4213 S 81ST DR
Practice Address - Street 2:
Practice Address - City:PHOENIX
Practice Address - State:AZ
Practice Address - Zip Code:85043-1615
Practice Address - Country:US
Practice Address - Phone:860-778-2537
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2020-06-16
Last Update Date:2020-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health