MEDICARE: SHARON MARIE HERBST M.S.

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	11179	TX

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	85128L	OTHER	TX	BLUECROSSBLUESHIELD ID

General Provider Information

NPI Number	:	1558495523
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHARON MARIE HERBST M.S.

Provider Business Mailing Address
First Line	:	16815 ROYAL CREST DR
Second Line	:	SUITE 110
City	:	HOUSTON
State	:	TX
Zip	:	77058-2521
Country	:	US
Telephone Number	:	281-488-4431
Fax Number	:	281-488-1213

Provider Business Practice Location Address
First Line	:	16815 ROYAL CREST DR
Second Line	:	SUITE 110
City	:	HOUSTON
State	:	TX
Zip	:	77058-2521
Country	:	US
Telephone Number	:	281-488-4431
Fax Number	:	281-488-1213

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

Provider Enumeration Date	:	03/14/2007
Last Update Date	:	07/08/2007

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