MEDICARE: SHERITA GATEWOOD

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	LPC0000003473	TN

General Provider Information

NPI Number	:	1396118139
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERITA GATEWOOD

Provider Business Mailing Address
First Line	:	2670 UNION AVENUE EXT STE 610
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-4422
Country	:	US
Telephone Number	:	901-458-4000
Fax Number	:	901-458-0048

Provider Business Practice Location Address
First Line	:	2670 UNION AVENUE EXT STE 610
Second Line	:
City	:	MEMPHIS
State	:	TN
Zip	:	38112-4422
Country	:	US
Telephone Number	:	901-458-4000
Fax Number	:	901-458-0048

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

Provider Enumeration Date	:	11/02/2015
Last Update Date	:	11/02/2015

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Directions to “ SHERITA GATEWOOD ” Practice Location

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