1770836777 NPI number — SHERRY DENISE AGARD MS, LPC, NCC, CLC

Table of content: SHERRY DENISE AGARD MS, LPC, NCC, CLC (NPI 1770836777)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770836777 NPI number — SHERRY DENISE AGARD MS, LPC, NCC, CLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
AGARD
Provider First Name:
SHERRY
Provider Middle Name:
DENISE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
MS, LPC, NCC, CLC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
AGARD-RAMOS
Provider Other First Name:
SHERRY
Provider Other Middle Name:
DENISE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1770836777
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
11/06/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
05/14/2013
NPI Reactivation Date:
12/11/2013

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
114 DALTREY CT
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MOUNTVILLE
Provider Business Mailing Address State Name:
PA
Provider Business Mailing Address Postal Code:
17554-1875
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1055 S. HOUSTON, AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TULSA
Provider Business Practice Location Address State Name:
OK
Provider Business Practice Location Address Postal Code:
74127
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
918-921-3200
Provider Business Practice Location Address Fax Number:
918-921-3294
Provider Enumeration Date:
10/16/2012

Additional Information

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101Y00000X , registered in the state of PA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)





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