Provider Demographics
NPI:1295069052
Name:SHIELDS, SHERRY LYNN (LPC)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LYNN
Last Name:SHIELDS
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 205
Mailing Address - Street 2:
Mailing Address - City:HOMER CITY
Mailing Address - State:PA
Mailing Address - Zip Code:15748-0205
Mailing Address - Country:US
Mailing Address - Phone:877-831-5059
Mailing Address - Fax:
Practice Address - Street 1:400 DEPOT ST
Practice Address - Street 2:
Practice Address - City:LATROBE
Practice Address - State:PA
Practice Address - Zip Code:15650-1537
Practice Address - Country:US
Practice Address - Phone:877-831-5059
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-09-28
Last Update Date:2023-06-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
PAPC005307101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional