Healthcare Provider Details

I. General information

NPI: 1215029335
Provider Name (Legal Business Name): ANGELYN D SHERROD M.S. LPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 09/28/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

210 MANOR ST
MARION AR
72364-1936
US

IV. Provider business mailing address

811 E PARKWAY S
MEMPHIS TN
38104-5523
US

V. Phone/Fax

Practice location:
  • Phone: 870-739-6818
  • Fax:
Mailing address:
  • Phone: 901-230-2268
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number04-08E
License Number StateAR

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: