Individual provider Active NPI

Jacqueline Belle Sherman, PHD

  • Clinical Psychologist
  • Lewistown, MT
National Provider Identifier
1366580144
Registry record updated Jun 28, 2011
On this page

Key facts

NPPES NPI Registry
Primary specialty
Clinical PsychologistTaxonomy code 103TC0700X
License
335 Issued in MT
Practice address
207 W Main St
Suite 3
Lewistown, MT 59457-2718
Phone
(406) 350-1807
Fax
(406) 535-6450
NPI assigned
Feb 2, 2007
Sex
Female
Sole proprietor
No

NPPES NPI Registry

Updated by the provider on Jun 28, 2011

Registry information is reported by the provider to CMS and is not verified. About this source

Specialties & licenses 1

Specialty (taxonomy)CodeLicenseStatePrimary
Clinical Psychologist 103TC0700X 335 MT Primary

Addresses

Primary practice location

207 W Main St
Suite 3
Lewistown, MT 59457-2718

Mailing address

207 W Main St
Suite 3
Lewistown, MT 59457-2718
Phone (406) 350-1807

Other identifiers 2

IdentifierTypeStateIssuer
0491402MedicaidMT
52371OtherMTBLUE CROSS BLUE SHIELD OF

Medicare participation

Medicare enrollment files
Medicare fee-for-service enrollment
Not listed in the public Medicare enrollment file

National Provider Directory

National Provider Directory
Medicare enrollment (NPD)
Enrolled
Credentials
Doctor of Philosophy

State licenses

LicenseStateTypeSpecialty
335MTMDAudiologist

Practice roles

OrganizationSpecialtyStatusNew patients
South Central Montana Regional Mental Health Center Past Accepting new patients

Organizations & group practices 1

Organizations this provider is connected to: Medicare benefit reassignments (the organization bills Medicare for this provider’s services), Care Compare group memberships and National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1170374400000",
    "enumeration_type": "NPI-1",
    "last_updated_epoch": "1309219200000",
    "number": "1366580144",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "207 W MAIN ST",
            "address_2": "SUITE 3",
            "city": "LEWISTOWN",
            "state": "MT",
            "postal_code": "594572718",
            "telephone_number": "406-350-1807",
            "fax_number": "406-535-6450"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "207 W MAIN ST",
            "address_2": "SUITE 3",
            "city": "LEWISTOWN",
            "state": "MT",
            "postal_code": "594572718",
            "telephone_number": "406-350-1807",
            "fax_number": "406-535-6450"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "last_name": "SHERMAN",
        "first_name": "JACQUELINE",
        "middle_name": "BELLE",
        "name_prefix": "Dr.",
        "credential": "PHD",
        "sole_proprietor": "NO",
        "sex": "F",
        "enumeration_date": "2007-02-02",
        "last_updated": "2011-06-28",
        "status": "A"
    },
    "taxonomies": [
        {
            "code": "103TC0700X",
            "taxonomy_group": "",
            "desc": "Psychologist, Clinical",
            "state": "MT",
            "license": "335",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "0491402",
            "state": "MT"
        },
        {
            "code": "01",
            "desc": "Other (non-Medicare)",
            "issuer": "BLUE CROSS BLUE SHIELD OF",
            "identifier": "52371",
            "state": "MT"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Lewistown, MT

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jun 28, 2011; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.