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General NPI Number Information
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NPI Number | 1053784918
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Entity Type | Individual
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Provider Name | SHERRY BOULDIN LPC
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Gender | Female
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Dates
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Enumeration Date | 11/01/2015
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Last Update Date | 09/17/2025
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Provider Practice Location Address
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Address Line | 4500 I 55 N SUITE 220
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City | JACKSON
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State | MS
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Zip | 39211-5930
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Country | US
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Telephone | 601-927-8729
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Fax |
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Provider Business Mailing Address
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Address Line | PO BOX 12195
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City | JACKSON
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State | MS
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Zip | 39236-2195
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Country | US
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Telephone | 601-292-6260
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Fax |
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 101YM0800X
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Taxonomy Name | Mental Health Counselor
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License Number | 1995
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License Number State | MS
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Taxonomy #2
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Taxonomy Code | 101Y00000X
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Taxonomy Name | Counselor
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License Number | 1995
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License Number State | MS
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Taxonomy #3
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Taxonomy Code | 103K00000X
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Taxonomy Name | Behavior Analyst
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License Number | 1995
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License Number State | MS
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Taxonomy #4
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Taxonomy Code | 102L00000X
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Taxonomy Name | Psychoanalyst
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License Number | 1995
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License Number State | MS
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Taxonomy #5
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Taxonomy Code | 101YP2500X
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Taxonomy Name | Professional Counselor
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License Number | 1995
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License Number State | MS
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