MEDICARE: EBONY SHERMAN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	101YP2500X	Professional Counselor

General Provider Information

NPI Number	:	1366978140
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	EBONY SHERMAN

Provider Business Mailing Address
First Line	:	245 E CENTENNIAL PKWY APT 2128
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-1373
Country	:	US
Telephone Number	:	937-207-2583
Fax Number	:

Provider Business Practice Location Address
First Line	:	245 E CENTENNIAL PKWY APT 2128
Second Line	:
City	:	NORTH LAS VEGAS
State	:	NV
Zip	:	89084-1373
Country	:	US
Telephone Number	:	937-207-2583
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	05/11/2017
Last Update Date	:	05/11/2017

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Directions to “ EBONY SHERMAN ” Practice Location

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