Provider Demographics
NPI:1205919651
Name:L. MICHAEL SHERROD, PH.D, , P.C.
Entity type:Organization
Organization Name:L. MICHAEL SHERROD, PH.D, , P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:L.
Authorized Official - Middle Name:MICHAEL
Authorized Official - Last Name:SHERROD
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:865-691-2425
Mailing Address - Street 1:9217 PARK WEST BLVD
Mailing Address - Street 2:SUITE D1
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37923-4404
Mailing Address - Country:US
Mailing Address - Phone:865-691-2425
Mailing Address - Fax:865-531-8440
Practice Address - Street 1:9217 PARK WEST BLVD
Practice Address - Street 2:SUITE D1
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37923-4404
Practice Address - Country:US
Practice Address - Phone:865-691-2425
Practice Address - Fax:865-531-8440
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-21
Last Update Date:2008-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN532103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN0014156OtherBCBSTN
TN5226618OtherAETNA
TN9455777OtherPHCS
TN23871OtherCIGNABEHAVIORALHEALTH
TN3683167Medicaid
TN932OtherPRIME PROVIDER SYSTEMS
TN257987OtherCOMPSYCH
TN=========OtherCIGNA
TN5226618OtherAETNA
TN=========OtherTENN. BEHAVIORAL HEALTH
TN=========OtherTENN. BEHAVIORAL HEALTH