Healthcare Provider Details

I. General information

NPI: 1518016617
Provider Name (Legal Business Name): SHERYLL LYNN PRINZ-MCMILLAN LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 01/09/2007
Last Update Date: 05/13/2021
Certification Date: 05/13/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

473 E. CARNEGIE DR. SUITE 200
SAN BERNARDINO CA
92408
US

IV. Provider business mailing address

473 E CARNEGIE DR SUITE 200 SAN BERNARDINO CA 92408 SUITE 200
SAN BERNARDINO CA
92408
US

V. Phone/Fax

Practice location:
  • Phone: 909-312-0607
  • Fax:
Mailing address:
  • Phone: 909-312-0607
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberMFC 32944
License Number StateCA
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number
License Number StateCA
# 3
Primary TaxonomyN
Taxonomy Code101YP1600X
TaxonomyPastoral Counselor
License Number
License Number StateCA
# 4
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License NumberMFC 32944
License Number StateCA

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: