Provider Demographics
NPI:1134404049
Name:SHERROD, LAILA BAYANI (LCSW)
Entity type:Individual
Prefix:MRS
First Name:LAILA
Middle Name:BAYANI
Last Name:SHERROD
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:LAILA
Other - Middle Name:
Other - Last Name:BAYANI
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:816 E OLDHAM AVE
Mailing Address - Street 2:
Mailing Address - City:KNOXVILLE
Mailing Address - State:TN
Mailing Address - Zip Code:37917-5567
Mailing Address - Country:US
Mailing Address - Phone:865-523-9163
Mailing Address - Fax:865-525-2958
Practice Address - Street 1:816 E OLDHAM AVE
Practice Address - Street 2:
Practice Address - City:KNOXVILLE
Practice Address - State:TN
Practice Address - Zip Code:37917-5567
Practice Address - Country:US
Practice Address - Phone:865-523-9163
Practice Address - Fax:865-525-2958
Is Sole Proprietor?:No
Enumeration Date:2011-10-12
Last Update Date:2016-08-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X
TN93571041C0700X
TN6043101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TNQ016587Medicaid