MEDICARE: SHERRELL FAIRLEY LMFT

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	106H00000X	Marriage & Family Therapist	84224	CA
2	225400000X	Rehabilitation Practitioner
3	106H00000X	Marriage & Family Therapist	112429	CA

General Provider Information

NPI Number	:	1427479278
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SHERRELL FAIRLEY LMFT

Provider Business Mailing Address
First Line	:	5198 ARLINGTON AVE # 647
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2603
Country	:	US
Telephone Number	:	951-572-2691
Fax Number	:

Provider Business Practice Location Address
First Line	:	5198 ARLINGTON AVE # 647
Second Line	:
City	:	RIVERSIDE
State	:	CA
Zip	:	92504-2603
Country	:	US
Telephone Number	:	951-572-2691
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	12/20/2013
Last Update Date	:	07/28/2024

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