Provider Demographics
NPI:1669625190
Name:WOOLWINE, SHERRY ANN (MS, MED, LPC)
Entity type:Individual
Prefix:MS
First Name:SHERRY
Middle Name:ANN
Last Name:WOOLWINE
Suffix:
Gender:F
Credentials:MS, MED, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1200 E TAMARACK RD
Mailing Address - Street 2:
Mailing Address - City:ALTUS
Mailing Address - State:OK
Mailing Address - Zip Code:73521-1234
Mailing Address - Country:US
Mailing Address - Phone:580-482-4095
Mailing Address - Fax:580-481-2499
Practice Address - Street 1:1200 E TAMARACK RD
Practice Address - Street 2:
Practice Address - City:ALTUS
Practice Address - State:OK
Practice Address - Zip Code:73521-1234
Practice Address - Country:US
Practice Address - Phone:580-482-4095
Practice Address - Fax:580-481-2499
Is Sole Proprietor?:No
Enumeration Date:2008-10-28
Last Update Date:2008-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK3264101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional