Provider Demographics
NPI:1023203320
Name:SHERVEY, SHEILA M (MFT)
Entity Type:Individual
Prefix:
First Name:SHEILA
Middle Name:M
Last Name:SHERVEY
Suffix:
Gender:F
Credentials:MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:19175 N 95TH PL
Mailing Address - Street 2:
Mailing Address - City:SCOTTSDALE
Mailing Address - State:AZ
Mailing Address - Zip Code:85255-5573
Mailing Address - Country:US
Mailing Address - Phone:818-585-2760
Mailing Address - Fax:
Practice Address - Street 1:19175 N 95TH PL
Practice Address - Street 2:
Practice Address - City:SCOTTSDALE
Practice Address - State:AZ
Practice Address - Zip Code:85255-5573
Practice Address - Country:US
Practice Address - Phone:818-585-2760
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-09-10
Last Update Date:2021-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 261QM0850X
CA53680106H00000X
AZ15266106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ15266OtherMARRIAGE AND FAMILY THERAPY LICENSE
CA53680OtherMARRIAGE AND FAMILY THERAPY LICENSE