Provider Demographics
NPI:1730265182
Name:LOEB, SHERRY J (LPC)
Entity type:Individual
Prefix:
First Name:SHERRY
Middle Name:J
Last Name:LOEB
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:MRS
Other - First Name:SHERRY
Other - Middle Name:JO
Other - Last Name:BUTLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:LPC
Mailing Address - Street 1:12 BAYVILLA LN
Mailing Address - Street 2:
Mailing Address - City:BAYTOWN
Mailing Address - State:TX
Mailing Address - Zip Code:77520-2103
Mailing Address - Country:US
Mailing Address - Phone:713-818-8392
Mailing Address - Fax:281-838-3535
Practice Address - Street 1:13012 HWY N 146
Practice Address - Street 2:
Practice Address - City:DAYTON
Practice Address - State:TX
Practice Address - Zip Code:77535-2804
Practice Address - Country:US
Practice Address - Phone:713-818-8392
Practice Address - Fax:281-576-4506
Is Sole Proprietor?:Yes
Enumeration Date:2006-10-28
Last Update Date:2009-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX16265101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX181058202Medicaid