MEDICARE: SHERRY MALCOMB GILL M.A.

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	101YM0800X	Mental Health Counselor	9829	TX
2	106H00000X	Marriage & Family Therapist	3491	TX

General Provider Information

NPI Number	:	1245393792
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRY MALCOMB GILL M.A.

Provider Business Mailing Address
First Line	:	14100 SOUTHWEST FWY
Second Line	:	SUITE 240
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3466
Country	:	US
Telephone Number	:	281-491-4455
Fax Number	:	281-491-3565

Provider Business Practice Location Address
First Line	:	14100 SOUTHWEST FWY
Second Line	:	SUITE 240
City	:	SUGAR LAND
State	:	TX
Zip	:	77478-3466
Country	:	US
Telephone Number	:	281-491-4455
Fax Number	:	281-491-3565

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/18/2006
Last Update Date	:	06/13/2012

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