Basic Information
| Provider Information | |||||||||
| NPI: | 1528552437 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | BRADY | ||||||||
| FirstName: | SHERI | ||||||||
| MiddleName: | LORENA | ||||||||
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| Mailing Information | |||||||||
| Address1: | 721 W BUENA VISTA ST | ||||||||
| Address2: | |||||||||
| City: | BARSTOW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 923112614 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7607187005 | ||||||||
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| Practice Location | |||||||||
| Address1: | 309 E. MT. VIEW SUITE 100 | ||||||||
| Address2: | |||||||||
| City: | BARSTOW | ||||||||
| State: | CA | ||||||||
| PostalCode: | 92311 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7602567279 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 06/15/2018 | ||||||||
| LastUpdateDate: | 06/15/2018 | ||||||||
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| ProviderGenderCode: | F | ||||||||
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| IsSoleProprietor: | Y | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 101YM0800X | 1265838023 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.