Provider Demographics
NPI:1982923454
Name:VAITKUS, SHERYL FRIZZELL
Entity Type:Individual
Prefix:
First Name:SHERYL
Middle Name:FRIZZELL
Last Name:VAITKUS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:125 PARK CIR
Mailing Address - Street 2:
Mailing Address - City:TEXARKANA
Mailing Address - State:TX
Mailing Address - Zip Code:75503-3201
Mailing Address - Country:US
Mailing Address - Phone:903-277-9183
Mailing Address - Fax:
Practice Address - Street 1:4080 SUMMERHILL SQ
Practice Address - Street 2:
Practice Address - City:TEXARKANA
Practice Address - State:TX
Practice Address - Zip Code:75503-2730
Practice Address - Country:US
Practice Address - Phone:903-793-7994
Practice Address - Fax:903-793-7996
Is Sole Proprietor?:Yes
Enumeration Date:2010-05-24
Last Update Date:2010-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX17239101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional