Provider Demographics
NPI:1144484437
Name:SHERMAN, MARK EDEN (LCSW)
Entity type:Individual
Prefix:
First Name:MARK
Middle Name:EDEN
Last Name:SHERMAN
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6504 NW OAK AVE # B-11
Mailing Address - Street 2:
Mailing Address - City:LAWTON
Mailing Address - State:OK
Mailing Address - Zip Code:73505-4367
Mailing Address - Country:US
Mailing Address - Phone:816-200-9572
Mailing Address - Fax:
Practice Address - Street 1:4301 NW WILSON ROAD
Practice Address - Street 2:BH UNIT
Practice Address - City:FT SILL
Practice Address - State:OK
Practice Address - Zip Code:73503-4472
Practice Address - Country:US
Practice Address - Phone:580-558-8283
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-15
Last Update Date:2022-02-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO0019631041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical