=====================================================
General NPI Number Information
=====================================================
NPI Number | 1497901771
-----------------------------------------------------
Entity Type | Individual
-----------------------------------------------------
Provider Name | CHRISTINA S SHERMAN PH.D., MFT
-----------------------------------------------------
Gender | Female
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 08/18/2008
-----------------------------------------------------
Last Update Date | 02/08/2010
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 577 E ELDER ST SUITE C
-----------------------------------------------------
City | FALLBROOK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92028-3079
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-419-7683
-----------------------------------------------------
Fax | 760-728-7872
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2140
-----------------------------------------------------
City | FALLBROOK
-----------------------------------------------------
State | CA
-----------------------------------------------------
Zip | 92088-2140
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 760-419-7683
-----------------------------------------------------
Fax | 760-728-7872
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position |
-----------------------------------------------------
Name |
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone |
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 106H00000X
-----------------------------------------------------
Taxonomy Name | Marriage & Family Therapist
-----------------------------------------------------
License Number | MFC37775
-----------------------------------------------------
License Number State | CA
-----------------------------------------------------