1730265182 NPI number — SHERRY J LOEB LPC

Table of content: SHERRY J LOEB LPC (NPI 1730265182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730265182 NPI number — SHERRY J LOEB LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
LOEB
Provider First Name:
SHERRY
Provider Middle Name:
J
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
BUTLER
Provider Other First Name:
SHERRY
Provider Other Middle Name:
JO
Provider Other Name Prefix Text:
MRS.
Provider Other Name Suffix Text:
Provider Other Credential Text:
LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1730265182
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
10/01/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12 BAYVILLA LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BAYTOWN
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77520-2103
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-818-8392
Provider Business Mailing Address Fax Number:
281-838-3535

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13012 HWY N 146
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DAYTON
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77535-2804
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-818-8392
Provider Business Practice Location Address Fax Number:
281-576-4506
Provider Enumeration Date:
10/28/2006

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: 101YP2500X , with the licence number:  16265 , registered in the state of TX ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 181058202 , issued by the state of ( TX ) . This identifiers is of the category "MEDICAID".




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