Sherry Ann Blake, BA
Individual provider Active NPI Mental Health Counselor · Gautier, MS
NPI 1720179054 · NPPES record last updated Apr 6, 2016
Key facts
- NPI
- 1720179054
- Entity type
- Individual (NPI type 1)
- Primary specialty
- Mental Health Counselor 101YM0800X
- Practice address
- 3407 Shamrock CT
Gautier, MS 39553-5337 - Phone
- (228) 497-0690
- NPI assigned
- Sep 28, 2006
- Sex
- Female
- Sole proprietor
- No
Medicare participation
- Medicare fee-for-service enrollment
- Not listed in the public Medicare enrollment file
National Provider Directory
- Medicare enrollment (NPD)
- No
- Credentials
- Bachelor of Arts
Specialties & licenses
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Mental Health Counselor | 101YM0800X | Yes |
Addresses
Primary practice location
3407 Shamrock CT
Gautier, MS 39553-5337
Mailing address
3407 Shamrock CT
Gautier, MS 39553-5337
Phone (228) 497-0690
Other identifiers
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 00018214 | Medicaid | MS |
Other providers in Gautier, MS
- Pamela Rae Benjaman
- Michael Bierdeman
- Biloxi Regional Medical Center
- Glenda Elaine Black
- Keisha L Black
- Chasity Chere' Blakely
- Estella L Bolton
- Alicia Diane Bonner
- Vicki Booker
- Mykayla Boone
All providers in Gautier, MS · Mental Health Counselor in Mississippi
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Record last updated by the provider on Apr 6, 2016. Information in NPPES is self-reported and not verified by CMS.
- NUCC Health Care Provider Taxonomy: specialty names.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.