Basic Information
| Provider Information | |||||||||
| NPI: | 1750665253 | ||||||||
| EntityType: | 1 | ||||||||
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| OrganizationName: | |||||||||
| LastName: | SINGH | ||||||||
| FirstName: | SHERRY | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4256 W PALO ALTO AVE | ||||||||
| Address2: | |||||||||
| City: | FRESNO | ||||||||
| State: | CA | ||||||||
| PostalCode: | 937229792 | ||||||||
| CountryCode: | US | ||||||||
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| Practice Location | |||||||||
| Address1: | 1234 EMPIRE ST STE 1500 | ||||||||
| Address2: | |||||||||
| City: | FAIRFIELD | ||||||||
| State: | CA | ||||||||
| PostalCode: | 945335711 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 5104148908 | ||||||||
| FaxNumber: | 7074194952 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 10/03/2011 | ||||||||
| LastUpdateDate: | 02/19/2019 | ||||||||
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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 | 73957 | CA | N | Behavioral Health & Social Service Providers | Counselor | Mental Health | 106H00000X | 52512 | CA | N | Behavioral Health & Social Service Providers | Marriage & Family Therapist | 101YM0800X | 111795 | CA | Y | Behavioral Health & Social Service Providers | Counselor | Mental Health |
No ID Information.