Provider Demographics
NPI:1205149457
Name:SHERWOOD, GREG C (MFT)
Entity type:Individual
Prefix:MR
First Name:GREG
Middle Name:C
Last Name:SHERWOOD
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 1:12439 MAGNOLIA BLVD.
Mailing Address - Street 2:132
Mailing Address - City:VALLEY VILLAGE
Mailing Address - State:CA
Mailing Address - Zip Code:91607
Mailing Address - Country:US
Mailing Address - Phone:818-559-2505
Mailing Address - Fax:818-784-2505
Practice Address - Street 1:22900 VENTURA BLVD.
Practice Address - Street 2:260
Practice Address - City:WOODLAND HILLS
Practice Address - State:CA
Practice Address - Zip Code:91364
Practice Address - Country:US
Practice Address - Phone:818-590-2505
Practice Address - Fax:818-784-2505
Is Sole Proprietor?:Yes
Enumeration Date:2010-07-16
Last Update Date:2010-07-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAM16625106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist