Provider Demographics
NPI:1124742747
Name:DAGLEY, SHERESA MICHELLE (MS, LPC)
Entity type:Individual
Prefix:
First Name:SHERESA
Middle Name:MICHELLE
Last Name:DAGLEY
Suffix:
Gender:F
Credentials:MS, LPC
Other - Prefix:
Other - First Name:SHERESA
Other - Middle Name:MICHELLE
Other - Last Name:SEQUIN DAGLEY
Other - Suffix:
Other - Last Name Type:Other Name
Other - Credentials:MS, LPC
Mailing Address - Street 1:924 ELLIOTT DR
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75104-9272
Mailing Address - Country:US
Mailing Address - Phone:832-466-4796
Mailing Address - Fax:
Practice Address - Street 1:1835 E SOUTHLAKE BLVD
Practice Address - Street 2:
Practice Address - City:SOUTHLAKE
Practice Address - State:TX
Practice Address - Zip Code:76092-6501
Practice Address - Country:US
Practice Address - Phone:817-769-7687
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-09-27
Last Update Date:2024-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX85081101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional