Healthcare Provider Details

I. General information

NPI: 1073647632
Provider Name (Legal Business Name): SHERI LYNN TRIPP M.S. MFT INTERN
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 03/15/2007
Last Update Date: 12/14/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2450 SOUTH ATLANTIC BLVD.
COMMERCE CA
90040
US

IV. Provider business mailing address

1907 BOYS REPUBLIC DRIVE
CHINO HILLS CA
91709
US

V. Phone/Fax

Practice location:
  • Phone: 323-318-9960
  • Fax: 323-780-3211
Mailing address:
  • Phone: 909-628-1217
  • Fax: 909-627-9222

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberIMF68123
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: