Provider Demographics
NPI:1649501131
Name:GOOSBY, SHERRY TEREASE
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:TEREASE
Last Name:GOOSBY
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHERRY
Other - Middle Name:TEREASE
Other - Last Name:GOOSBY
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:MA, LLPC
Mailing Address - Street 1:3737 LAWTON ST
Mailing Address - Street 2:
Mailing Address - City:DETROIT
Mailing Address - State:MI
Mailing Address - Zip Code:48208-2500
Mailing Address - Country:US
Mailing Address - Phone:313-361-6136
Mailing Address - Fax:313-361-6211
Practice Address - Street 1:3737 LAWTON ST
Practice Address - Street 2:
Practice Address - City:DETROIT
Practice Address - State:MI
Practice Address - Zip Code:48208-2500
Practice Address - Country:US
Practice Address - Phone:313-361-6136
Practice Address - Fax:313-361-6211
Is Sole Proprietor?:No
Enumeration Date:2010-01-22
Last Update Date:2012-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MI6401012425101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor
Provider Identifiers
StateIdentifier IDID TypeIssuer
MI1649501131OtherCLINICAL THERAPIST