Provider Demographics
NPI:1528204047
Name:NICHOLS, SHARYN (MFT)
Entity Type:Individual
Prefix:
First Name:SHARYN
Middle Name:
Last Name:NICHOLS
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 1:17547 VENTURA BLVD
Mailing Address - Street 2:SUITE 310
Mailing Address - City:ENCINO
Mailing Address - State:CA
Mailing Address - Zip Code:91316-3853
Mailing Address - Country:US
Mailing Address - Phone:818-995-0368
Mailing Address - Fax:
Practice Address - Street 1:17547 VENTURA BLVD
Practice Address - Street 2:SUITE 310
Practice Address - City:ENCINO
Practice Address - State:CA
Practice Address - Zip Code:91316-3853
Practice Address - Country:US
Practice Address - Phone:818-995-0368
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-01-06
Last Update Date:2009-01-06
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA37108106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist