Provider Demographics
NPI:1699852889
Name:RUSSELL, SHERI LYNN (MFT)
Entity Type:Individual
Prefix:MRS
First Name:SHERI
Middle Name:LYNN
Last Name:RUSSELL
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 1:7877 WREN AVE STE A
Mailing Address - Street 2:
Mailing Address - City:GILROY
Mailing Address - State:CA
Mailing Address - Zip Code:95020-4980
Mailing Address - Country:US
Mailing Address - Phone:408-710-2001
Mailing Address - Fax:408-848-0015
Practice Address - Street 1:7877 WREN AVE STE A
Practice Address - Street 2:
Practice Address - City:GILROY
Practice Address - State:CA
Practice Address - Zip Code:95020-4980
Practice Address - Country:US
Practice Address - Phone:408-710-2001
Practice Address - Fax:408-848-0015
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-01
Last Update Date:2012-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC44969106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist