Provider Demographics
NPI:1306937040
Name:GORDON, SHERYLE D (PHD)
Entity type:Individual
Prefix:DR
First Name:SHERYLE
Middle Name:D
Last Name:GORDON
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:DR
Other - First Name:SHERYLE
Other - Middle Name:G
Other - Last Name:BEATTY
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:PHD
Mailing Address - Street 1:1933 STONEHAVEN
Mailing Address - Street 2:
Mailing Address - City:SAN MARCOS
Mailing Address - State:TX
Mailing Address - Zip Code:78666-2365
Mailing Address - Country:US
Mailing Address - Phone:512-496-5947
Mailing Address - Fax:866-590-6815
Practice Address - Street 1:1409 N. BISHOP STREET
Practice Address - Street 2:SUITE 4-C
Practice Address - City:SAN MARCOS
Practice Address - State:TX
Practice Address - Zip Code:78666-2675
Practice Address - Country:US
Practice Address - Phone:512-496-5947
Practice Address - Fax:866-590-5947
Is Sole Proprietor?:Yes
Enumeration Date:2006-09-27
Last Update Date:2022-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX25431103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX029552903Medicaid
TX029552903Medicaid