Provider Demographics
NPI:1831302496
Name:SHERE, JIM (MFT)
Entity Type:Individual
Prefix:MR
First Name:JIM
Middle Name:
Last Name:SHERE
Suffix:
Gender:M
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:PO BOX 2108
Mailing Address - Street 2:
Mailing Address - City:GLEN ELLEN
Mailing Address - State:CA
Mailing Address - Zip Code:95442-2108
Mailing Address - Country:US
Mailing Address - Phone:707-935-3663
Mailing Address - Fax:
Practice Address - Street 1:14301 ARNOLD DR
Practice Address - Street 2:
Practice Address - City:GLEN ELLEN
Practice Address - State:CA
Practice Address - Zip Code:95442-9400
Practice Address - Country:US
Practice Address - Phone:707-935-3663
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-08
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAMFC8847106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist