Provider Demographics
NPI:1649508250
Name:TRAIL, SHARYL M (PSYD)
Entity type:Individual
Prefix:DR
First Name:SHARYL
Middle Name:M
Last Name:TRAIL
Suffix:
Gender:F
Credentials:PSYD
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 5907
Mailing Address - Street 2:
Mailing Address - City:ALAMO
Mailing Address - State:NM
Mailing Address - Zip Code:87825-5907
Mailing Address - Country:US
Mailing Address - Phone:575-854-2610
Mailing Address - Fax:575-854-2616
Practice Address - Street 1:ALAMO NAVAJO HEALTH CLINIC
Practice Address - Street 2:MILEPOST 29 HWY 169
Practice Address - City:ALAMO
Practice Address - State:NM
Practice Address - Zip Code:87825-5907
Practice Address - Country:US
Practice Address - Phone:575-854-2610
Practice Address - Fax:575-854-2616
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-20
Last Update Date:2011-05-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS1825103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical