1609409705 NPI number — MRS. SHERYL TRULUCK EAST LMSW

Table of content: MRS. SHERYL TRULUCK EAST LMSW (NPI 1609409705)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1609409705 NPI number — MRS. SHERYL TRULUCK EAST LMSW

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
EAST
Provider First Name:
SHERYL
Provider Middle Name:
TRULUCK
Provider Name Prefix Text:
MRS.
Provider Name Suffix Text:
Provider Credential Text:
LMSW
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1609409705
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
02/17/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
80 CYPRESS TRAIL
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAKELAND
Provider Business Mailing Address State Name:
GA
Provider Business Mailing Address Postal Code:
31635-4355
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
229-412-3127
Provider Business Mailing Address Fax Number:
229-482-9653

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
80 CYPRESS TRL
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
LAKELAND
Provider Business Practice Location Address State Name:
GA
Provider Business Practice Location Address Postal Code:
31635-5433
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
229-412-3127
Provider Business Practice Location Address Fax Number:
229-482-9653
Provider Enumeration Date:
02/17/2020

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 ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: MSW003355 . This is a "LICENSING BOARD OF PSYCHOLOGIST, SOCIAL WORKERS" identifier , issued by the state of ( GA ) . This identifiers is of the category "OTHER".




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