MEDICARE: L. MICHAEL SHERROD, PH.D, , P.C.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	103TC0700X	Clinical Psychologist	532	TN

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	0014156	OTHER	TN	BCBSTN
2	5226618	OTHER	TN	AETNA
3	9455777	OTHER	TN	PHCS
4	23871	OTHER	TN	CIGNABEHAVIORALHEALTH
5	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
6	932	OTHER	TN	PRIME PROVIDER SYSTEMS
7	257987	OTHER	TN	COMPSYCH

General Provider Information

NPI Number	:	1205919651
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	L. MICHAEL SHERROD, PH.D, , P.C.

Provider Business Mailing Address
First Line	:	9217 PARK WEST BLVD
Second Line	:	SUITE D1
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4404
Country	:	US
Telephone Number	:	865-691-2425
Fax Number	:	865-531-8440

Provider Business Practice Location Address
First Line	:	9217 PARK WEST BLVD
Second Line	:	SUITE D1
City	:	KNOXVILLE
State	:	TN
Zip	:	37923-4404
Country	:	US
Telephone Number	:	865-691-2425
Fax Number	:	865-531-8440

Authorized Official
Title or Position	:	PRESIDENT
Name	:	DR. L. MICHAEL SHERROD
Credential	:	PH.D.
Telephone Number	:	865-691-2425

Provider Enumeration Date	:	10/21/2006
Last Update Date	:	04/20/2008

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