Provider Demographics
NPI:1356702922
Name:EMERSON, SHERRY LEE
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:LEE
Last Name:EMERSON
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:230 N 3RD ST STE 105
Mailing Address - Street 2:
Mailing Address - City:HARRISBURG
Mailing Address - State:OR
Mailing Address - Zip Code:97446-9679
Mailing Address - Country:US
Mailing Address - Phone:541-998-5660
Mailing Address - Fax:541-995-5013
Practice Address - Street 1:230 N 3RD ST STE 105
Practice Address - Street 2:
Practice Address - City:HARRISBURG
Practice Address - State:OR
Practice Address - Zip Code:97446-9679
Practice Address - Country:US
Practice Address - Phone:541-998-5660
Practice Address - Fax:541-995-5013
Is Sole Proprietor?:No
Enumeration Date:2016-03-10
Last Update Date:2022-11-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OROR-10041-M101YA0400X
OR22-QMHP-R-1253101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR230475Medicaid