Healthcare Provider Details

I. General information

NPI: 1962592170
Provider Name (Legal Business Name): KARLA RAE SHERMAN MCP, LPC, NCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 10/16/2006
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1500 E WOODROW WILSON AVE MH-ADTP/116A4
JACKSON MS
39216-5116
US

IV. Provider business mailing address

853 ROBINWOOD DR
BYRAM MS
39272-6054
US

V. Phone/Fax

Practice location:
  • Phone: 601-362-4471
  • Fax: 601-364-1386
Mailing address:
  • Phone: 601-346-7750
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0782
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: