Healthcare Provider Details

I. General information

NPI: 1891742680
Provider Name (Legal Business Name): SHERLEAN D LYBOLT LPE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/27/2006
Last Update Date: 03/17/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

310 25TH AVE N STE 204
NASHVILLE TN
37203-2492
US

IV. Provider business mailing address

310 25TH AVE N STE 204
NASHVILLE TN
37203-2492
US

V. Phone/Fax

Practice location:
  • Phone: 615-385-4090
  • Fax: 615-385-0138
Mailing address:
  • Phone: 615-385-4090
  • Fax: 615-385-0138

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TC0700X
TaxonomyClinical Psychologist
License Number11728
License Number StateTN
# 2
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberPE11728
License Number StateTN

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: