Healthcare Provider Details

I. General information

NPI: 1548606320
Provider Name (Legal Business Name): SHERRY ELLEN MCRILL MA.,LLP
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/20/2013
Last Update Date: 05/20/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2900 CONNER ST BLDG A
DETROIT MI
48215-2407
US

IV. Provider business mailing address

1436 KENSINGTON AVE
GROSSE POINTE PARK MI
48230-1150
US

V. Phone/Fax

Practice location:
  • Phone: 313-824-5639
  • Fax: 313-824-5590
Mailing address:
  • Phone: 313-929-0159
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TC1900X
TaxonomyCounseling Psychologist
License Number6301006762
License Number StateMI

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: