Provider Demographics
NPI:1457417123
Name:SHERRY, ELIZABETH JONES (LPC)
Entity Type:Individual
Prefix:
First Name:ELIZABETH
Middle Name:JONES
Last Name:SHERRY
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 1:7537 BOSQUE BLVD
Mailing Address - Street 2:
Mailing Address - City:WACO
Mailing Address - State:TX
Mailing Address - Zip Code:76712-3713
Mailing Address - Country:US
Mailing Address - Phone:254-776-3235
Mailing Address - Fax:254-776-7405
Practice Address - Street 1:7537 BOSQUE BLVD
Practice Address - Street 2:
Practice Address - City:WACO
Practice Address - State:TX
Practice Address - Zip Code:76712-3713
Practice Address - Country:US
Practice Address - Phone:254-776-3235
Practice Address - Fax:254-776-7405
Is Sole Proprietor?:Yes
Enumeration Date:2006-12-28
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX14292101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX11262920OtherCAQH
TX6072LCOtherBLUE CROSS BLUE SHIELD
TXP-11228921OtherMULTIPLAN AND HEALTH EOS
TX285118OtherMANAGED HEALTH NETWORK
TX120690OtherCHIP
TX242540OtherCOMPSYCH
TX529538OtherVALUE OPTIONS