1184903155 NPI number — MRS. SHERRI DIANE BENTLEY LPCC-S

Table of content: MRS. SHERRI DIANE BENTLEY LPCC-S (NPI 1184903155)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1184903155 NPI number — MRS. SHERRI DIANE BENTLEY LPCC-S

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
BENTLEY
Provider First Name:
SHERRI
Provider Middle Name:
DIANE
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LPCC-S
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
CALDWELL
Provider Other First Name:
SHERRI
Provider Other Middle Name:
D
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPCC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1184903155
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
03/09/2021
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
37 PATTON CREEK RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
PENDLETON
Provider Business Mailing Address State Name:
KY
Provider Business Mailing Address Postal Code:
40055-8947
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
502-648-6988
Provider Business Mailing Address Fax Number:
502-331-6062

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
105 E WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LA GRANGE
Provider Business Practice Location Address State Name:
KY
Provider Business Practice Location Address Postal Code:
40031-1215
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
502-648-6988
Provider Business Practice Location Address Fax Number:
502-331-6062
Provider Enumeration Date:
08/09/2011

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: 101YM0800X , with the licence number:  173020 , registered in the state of KY ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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