Provider Demographics
NPI:1841467222
Name:SHERYL ANDIS, LCSW
Entity type:Organization
Organization Name:SHERYL ANDIS, LCSW
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHERYL
Authorized Official - Middle Name:A
Authorized Official - Last Name:ANDIS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:812-477-2350
Mailing Address - Street 1:3700 BELLEMEADE AVE
Mailing Address - Street 2:STE 110
Mailing Address - City:EVANSVILLE
Mailing Address - State:IN
Mailing Address - Zip Code:47714-0102
Mailing Address - Country:US
Mailing Address - Phone:812-477-2350
Mailing Address - Fax:812-477-2378
Practice Address - Street 1:3700 BELLEMEADE AVE
Practice Address - Street 2:STE 110
Practice Address - City:EVANSVILLE
Practice Address - State:IN
Practice Address - Zip Code:47714-0102
Practice Address - Country:US
Practice Address - Phone:812-477-2350
Practice Address - Fax:812-477-2378
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-14
Last Update Date:2008-05-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34002024A1041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN161950Medicare PIN
INR34352Medicare UPIN