Healthcare Provider Details

I. General information

NPI: 1831382092
Provider Name (Legal Business Name): SHERRILL ANN SCOTT LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/21/2007
Last Update Date: 08/21/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7010 S YALE AVE STE 215
TULSA OK
74136-5713
US

IV. Provider business mailing address

5303 E 12TH ST #25
TULSA OK
74112-5304
US

V. Phone/Fax

Practice location:
  • Phone: 918-492-2554
  • Fax:
Mailing address:
  • Phone: 405-209-3048
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number1337
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: