Provider Demographics
NPI:1396313185
Name:WHITE, SHERRY CHAFFIN (SR LPE)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:CHAFFIN
Last Name:WHITE
Suffix:
Gender:F
Credentials:SR LPE
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1000 STATE ROUTE U
Mailing Address - Street 2:
Mailing Address - City:CARUTHERSVILLE
Mailing Address - State:MO
Mailing Address - Zip Code:63830-2342
Mailing Address - Country:US
Mailing Address - Phone:573-757-8600
Mailing Address - Fax:
Practice Address - Street 1:BRIGHT BLUE HEALTH CENTER
Practice Address - Street 2:1055 VENDALL ROAD
Practice Address - City:DYERSBURG
Practice Address - State:TN
Practice Address - Zip Code:38024-1622
Practice Address - Country:US
Practice Address - Phone:731-882-7224
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-06-16
Last Update Date:2021-06-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000011525103T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist