Provider Demographics
NPI:1154379832
Name:STILLWELL, SHERI KAY (LCSW)
Entity type:Individual
Prefix:
First Name:SHERI
Middle Name:KAY
Last Name:STILLWELL
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 130459
Mailing Address - Street 2:
Mailing Address - City:TYLER
Mailing Address - State:TX
Mailing Address - Zip Code:75713-0459
Mailing Address - Country:US
Mailing Address - Phone:903-531-2500
Mailing Address - Fax:
Practice Address - Street 1:1814 ROSELAND BLVD
Practice Address - Street 2:SUITE 200
Practice Address - City:TYLER
Practice Address - State:TX
Practice Address - Zip Code:75701-4234
Practice Address - Country:US
Practice Address - Phone:903-531-2500
Practice Address - Fax:903-595-3785
Is Sole Proprietor?:No
Enumeration Date:2006-05-04
Last Update Date:2008-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX302391041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX8K4353OtherMEDICARE
TXB0082536Medicare UPIN