Provider Demographics
NPI:1730218504
Name:KELLY, SHERRY ANN (LCSW)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:ANN
Last Name:KELLY
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2121 W. SPRING CREEK PKWY SUITE 220
Mailing Address - Street 2:
Mailing Address - City:PLANO
Mailing Address - State:TX
Mailing Address - Zip Code:75023
Mailing Address - Country:US
Mailing Address - Phone:972-208-0760
Mailing Address - Fax:972-867-5688
Practice Address - Street 1:2121 W. SPRING CREEK PKWY SUITE 220
Practice Address - Street 2:
Practice Address - City:PLANO
Practice Address - State:TX
Practice Address - Zip Code:75023
Practice Address - Country:US
Practice Address - Phone:972-208-0760
Practice Address - Fax:972-867-5688
Is Sole Proprietor?:No
Enumeration Date:2007-03-05
Last Update Date:2015-07-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX256731041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX063879301Medicaid