MEDICARE: ELIZABETH JONES SHERRY L.P.C.

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	14292	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	11262920	OTHER	TX	CAQH
2	6072LC	OTHER	TX	BLUE CROSS BLUE SHIELD
3	P-11228921	OTHER	TX	MULTIPLAN AND HEALTH EOS
4	285118	OTHER	TX	MANAGED HEALTH NETWORK
5	120690	OTHER	TX	CHIP
6	242540	OTHER	TX	COMPSYCH
7	529538	OTHER	TX	VALUE OPTIONS

General Provider Information

NPI Number	:	1457417123
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	ELIZABETH JONES SHERRY L.P.C.

Provider Business Mailing Address
First Line	:	7537 BOSQUE BLVD
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-3713
Country	:	US
Telephone Number	:	254-776-3235
Fax Number	:	254-776-7405

Provider Business Practice Location Address
First Line	:	7537 BOSQUE BLVD
Second Line	:
City	:	WACO
State	:	TX
Zip	:	76712-3713
Country	:	US
Telephone Number	:	254-776-3235
Fax Number	:	254-776-7405

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

Provider Enumeration Date	:	12/28/2006
Last Update Date	:	07/08/2007

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