Provider Demographics
NPI:1457601817
Name:NUSSBAUM, SHERRI (LPC)
Entity type:Individual
Prefix:DR
First Name:SHERRI
Middle Name:
Last Name:NUSSBAUM
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1413 SECLUDED LANE
Mailing Address - Street 2:
Mailing Address - City:LONGVIEWT
Mailing Address - State:TX
Mailing Address - Zip Code:75604
Mailing Address - Country:US
Mailing Address - Phone:903-241-2947
Mailing Address - Fax:
Practice Address - Street 1:3400 WEST MARSHALL SUITE 309
Practice Address - Street 2:AUSTIN BANK BUILDING
Practice Address - City:LONGVIEW
Practice Address - State:TX
Practice Address - Zip Code:75604
Practice Address - Country:US
Practice Address - Phone:903-241-2947
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-09-13
Last Update Date:2012-09-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX62326101Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor