MEDICARE: DR. ALISSA SHERRY PH.D.

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	103T00000X	Psychologist	32248	TX
2	103TA0400X	Addiction (Substance Use Disorder) Psychologist	32248	TX
3	103TC1900X	Counseling Psychologist	32248	TX
4	103TF0000X	Family Psychologist	32248	TX
5	103TF0200X	Forensic Psychologist	32248	TX

General Provider Information

NPI Number	:	1750552808
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. ALISSA SHERRY PH.D.

Provider Business Mailing Address
First Line	:	707 W 10TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-2033
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	707 W 10TH ST
Second Line	:
City	:	AUSTIN
State	:	TX
Zip	:	78701-2033
Country	:	US
Telephone Number	:	512-791-4800
Fax Number	:

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

Provider Enumeration Date	:	03/17/2008
Last Update Date	:	03/17/2008

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