Healthcare Provider Details

I. General information

NPI: 1922456789
Provider Name (Legal Business Name): NICOLE SYLVIA IMHOF SHERROD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: NICOLE SYLVIA IMHOF

II. Dates (important events)

Enumeration Date: 06/01/2016
Last Update Date: 01/02/2025
Certification Date: 01/02/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6500 WILSHIRE BLVD STE 1100
LOS ANGELES CA
90048-4913
US

IV. Provider business mailing address

PO BOX 608
WOODLAND HILLS CA
91365-0608
US

V. Phone/Fax

Practice location:
  • Phone: 310-423-4238
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberIMF87651
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code221700000X
TaxonomyArt Therapist
License Number17-451
License Number State
# 3
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberLMFT102212
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: