Healthcare Provider Details

I. General information

NPI: 1699977306
Provider Name (Legal Business Name): ROGER L SHERRILL MA, LPC,NCC
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 06/04/2007
Last Update Date: 08/27/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

333 S CHERRY ST CHAMPIONS CHRISTIAN COUNSELING CENTER
TOMBALL TX
77375-6614
US

IV. Provider business mailing address

4815 EL SALVADOR DR
HOUSTON TX
77066-2600
US

V. Phone/Fax

Practice location:
  • Phone: 281-357-4111
  • Fax:
Mailing address:
  • Phone: 281-583-2028
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number62347
License Number StateTX

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: