Provider Demographics
NPI:1265566285
Name:REYNOLDS, SHERRILL LYNN (LCSW)
Entity type:Individual
Prefix:MS
First Name:SHERRILL
Middle Name:LYNN
Last Name:REYNOLDS
Suffix:
Gender:F
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 794
Mailing Address - Street 2:
Mailing Address - City:BIG BEAR CITY
Mailing Address - State:CA
Mailing Address - Zip Code:92314-0794
Mailing Address - Country:US
Mailing Address - Phone:909-732-7448
Mailing Address - Fax:
Practice Address - Street 1:41945 BIG BEAR BLVD
Practice Address - Street 2:SUITE #227
Practice Address - City:BIG BEAR LAKE
Practice Address - State:CA
Practice Address - Zip Code:92315
Practice Address - Country:US
Practice Address - Phone:909-732-7448
Practice Address - Fax:909-584-9018
Is Sole Proprietor?:Yes
Enumeration Date:2007-03-14
Last Update Date:2016-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CA081857101YA0400X
CA291421041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)