Provider Demographics
NPI:1609174929
Name:PONCE, SHERYLLEE TAMIKO (MA, MFT)
Entity Type:Individual
Prefix:MS
First Name:SHERYLLEE
Middle Name:TAMIKO
Last Name:PONCE
Suffix:
Gender:F
Credentials:MA, MFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4272 RICE ST STE C
Mailing Address - Street 2:
Mailing Address - City:LIHUE
Mailing Address - State:HI
Mailing Address - Zip Code:96766-1818
Mailing Address - Country:US
Mailing Address - Phone:808-651-0937
Mailing Address - Fax:
Practice Address - Street 1:4272 RICE ST STE C
Practice Address - Street 2:
Practice Address - City:LIHUE
Practice Address - State:HI
Practice Address - Zip Code:96766-1818
Practice Address - Country:US
Practice Address - Phone:808-651-0937
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-10
Last Update Date:2011-03-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
HI141106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist