Basic Information
Provider Information
NPI: 1316534530
EntityType: 1
ReplacementNPI:  
OrganizationName:  
LastName: SHERFEY
FirstName: JAMES
MiddleName: RICHARD
NamePrefix:  
NameSuffix: JR.
Credential:  
OtherOrganizationName:  
OtherOrganizationType:  
OtherLastName:  
OtherFirstName:  
OtherMiddleName:  
OtherNamePrefix:  
OtherNameSuffix:  
OtherCredential:  
OtherLastNameType:  
Mailing Information
Address1: 1855 E DUBLIN GRANVILLE RD
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432293516
CountryCode: US
TelephoneNumber: 6142677003
FaxNumber:  
Practice Location
Address1: 4897 KARL RD
Address2:  
City: COLUMBUS
State: OH
PostalCode: 432295147
CountryCode: US
TelephoneNumber: 6148462588
FaxNumber:  
Other Information
ProviderEnumerationDate: 12/22/2020
LastUpdateDate: 12/22/2020
NPIDeactivationReasonCode:  
NPIDeactivationDate:  
NPIReactivationDate:  
ProviderGenderCode: M
AuthorizedOfficialLastName:  
AuthorizedOfficialFirstName:  
AuthorizedOfficialMiddleName:  
AuthorizedOfficialTitleorPosition:  
AuthorizedOfficialTelephone:  
IsSoleProprietor: N
IsOrganizationSubpart:  
ParentOrganizationLBN:  
AuthorizedOfficialNamePrefix:  
AuthorizedOfficialNameSuffix:  
AuthorizedOfficialCredential:  
NPICertificationDate: 12/16/2020

Taxonomy Information
TaxonomyLicenseStateSwitchTaxonomyGroupTaxonomyTypeTaxonomyClassSubSpecialty
101YM0800X  Y Behavioral Health & Social Service ProvidersCounselorMental Health

No ID Information.


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