Provider Demographics
NPI:1639406812
Name:PHILLIPS, SHERIL ELIZABETH (MS)
Entity Type:Individual
Prefix:MS
First Name:SHERIL
Middle Name:ELIZABETH
Last Name:PHILLIPS
Suffix:
Gender:F
Credentials:MS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3069 LAKEMONT DR UNIT 3
Mailing Address - Street 2:
Mailing Address - City:SAN RAMON
Mailing Address - State:CA
Mailing Address - Zip Code:94582-4899
Mailing Address - Country:US
Mailing Address - Phone:925-735-6311
Mailing Address - Fax:
Practice Address - Street 1:305 TOWN CENTRE TER STE P
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:CA
Practice Address - Zip Code:94513-2226
Practice Address - Country:US
Practice Address - Phone:925-240-7144
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2009-11-10
Last Update Date:2009-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFT41538106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist