Active NPI
Sherri Young Theoharidis, PHD
- Professional Counselor
- Gladstone, MO
National Provider Identifier
1942421987
On this page
Key facts
NPPES NPI Registry- Primary specialty
- Professional Counselor
- License
- 2003028611
- Practice address
- 407 NE 76TH Terrace
Gladstone, MO 64118 - Phone
- (816) 436-7900
- Fax
- (816) 436-0999
- NPI assigned
- May 1, 2007
- Last updated
- Jul 8, 2007
- Sex
- Female
- Sole proprietor
- Yes
NPPES NPI Registry
Registry information is reported by the provider to CMS and is not verified. About this source
Specialties & licenses 1
| Specialty (taxonomy) | Code | License | State | Primary |
|---|---|---|---|---|
| Professional Counselor | 101YP2500X | 2003028611 | MO | Primary |
Addresses
Primary practice location
407 NE 76TH Terrace
Gladstone, MO 64118
Mailing address
407 NE 76TH Terrace
Gladstone, MO 64118
Phone (816) 436-7900
Other identifiers 1
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 753168731 | Other | MO | FEDERAL TAX ID |
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)
- Not enrolled
- Credentials
- Doctor of Philosophy
State licenses
| License | State | Type | Specialty |
|---|---|---|---|
| 2003028611 | MO | MD | Professional Counselor |
NPI Registry JSON
The complete NPPES record for this NPI in the NPI Registry API format.
{
"created_epoch": "1177977600000",
"enumeration_type": "NPI-1",
"last_updated_epoch": "1183852800000",
"number": "1942421987",
"addresses": [
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "MAILING",
"address_type": "DOM",
"address_1": "407 NE 76TH TERRACE",
"city": "GLADSTONE",
"state": "MO",
"postal_code": "64118",
"telephone_number": "816-436-7900",
"fax_number": "816-436-0999"
},
{
"country_code": "US",
"country_name": "United States",
"address_purpose": "LOCATION",
"address_type": "DOM",
"address_1": "407 NE 76TH TERRACE",
"city": "GLADSTONE",
"state": "MO",
"postal_code": "64118",
"telephone_number": "816-436-7900",
"fax_number": "816-436-0999"
}
],
"practiceLocations": [],
"basic": {
"last_name": "THEOHARIDIS",
"first_name": "SHERRI",
"middle_name": "YOUNG",
"name_prefix": "Dr.",
"credential": "PHD",
"sole_proprietor": "YES",
"sex": "F",
"enumeration_date": "2007-05-01",
"last_updated": "2007-07-08",
"status": "A"
},
"taxonomies": [
{
"code": "101YP2500X",
"taxonomy_group": "",
"desc": "Counselor, Professional",
"state": "MO",
"license": "2003028611",
"primary": true
}
],
"identifiers": [
{
"code": "01",
"desc": "Other (non-Medicare)",
"issuer": "FEDERAL TAX ID",
"identifier": "753168731",
"state": "MO"
}
],
"endpoints": [],
"other_names": []
}Other providers in Gladstone, MO
Sources for this page
- NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 8, 2007; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
- National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.