Provider Demographics
NPI:1669084000
Name:GROSS, SHERYL COURTNEY (MS)
Entity type:Individual
Prefix:
First Name:SHERYL
Middle Name:COURTNEY
Last Name:GROSS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8177 EMERALD WINDS CIR
Mailing Address - Street 2:
Mailing Address - City:BOYNTON BEACH
Mailing Address - State:FL
Mailing Address - Zip Code:33473-7837
Mailing Address - Country:US
Mailing Address - Phone:561-716-9006
Mailing Address - Fax:
Practice Address - Street 1:7051 SEACREST BLVD
Practice Address - Street 2:
Practice Address - City:LANTANA
Practice Address - State:FL
Practice Address - Zip Code:33462-5139
Practice Address - Country:US
Practice Address - Phone:561-296-5288
Practice Address - Fax:561-296-5288
Is Sole Proprietor?:No
Enumeration Date:2020-08-18
Last Update Date:2020-08-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
FLIMH7154101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health