MEDICARE: NICOLE SYLVIA IMHOF SHERROD

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	101YM0800X	Mental Health Counselor	IMF87651	CA
2	221700000X	Art Therapist	17-451
3	106H00000X	Marriage & Family Therapist	LMFT102212	CA

General Provider Information

NPI Number	:	1922456789
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	NICOLE SYLVIA IMHOF SHERROD

Provider Business Mailing Address
First Line	:	PO BOX 608
Second Line	:
City	:	WOODLAND HILLS
State	:	CA
Zip	:	91365-0608
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	6500 WILSHIRE BLVD STE 1100
Second Line	:
City	:	LOS ANGELES
State	:	CA
Zip	:	90048-4913
Country	:	US
Telephone Number	:	310-423-4238
Fax Number	:

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

Provider Enumeration Date	:	06/01/2016
Last Update Date	:	01/02/2025

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Directions to “ NICOLE SYLVIA IMHOF SHERROD ” Practice Location

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