Healthcare Provider Details

I. General information

NPI: 1649501131
Provider Name (Legal Business Name): SHERRY TEREASE GOOSBY
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: SHERRY TEREASE GOOSBY MA, LLPC

II. Dates (important events)

Enumeration Date: 01/22/2010
Last Update Date: 12/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3737 LAWTON ST
DETROIT MI
48208-2500
US

IV. Provider business mailing address

3737 LAWTON ST
DETROIT MI
48208-2500
US

V. Phone/Fax

Practice location:
  • Phone: 313-361-6136
  • Fax: 313-361-6211
Mailing address:
  • Phone: 313-361-6136
  • Fax: 313-361-6211

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License Number6401012425
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: