| Doctor Name: | TIM SHERRELL |
| NPI Number: | 1114086238 |
| Entity Type Code: | Individual (1) |
| Gender: | M |
| Credentials: | LCSW |
| License Number: | LCS15755 |
| Business Practice Address: | 9667 Highway 29 Suite 200 Lower Lake, CA - 95457 |
| Business Phone Number: | 7079946726 |
| Business Fax Number: | 7079983120 |
| Mailing Address: | Po Box 1656, LOWER LAKE |
| State: | CA |
| Postal Code: | 95457 |
| Phone Number: | 7079946726 |
| Fax Number: | 7079983120 |
| NPI Enumeration Date: | 12/06/2006 |
| NPI Last Update Date: | 06/07/2010 |
| Replacement NPI: | 0 |
| NPI Deactivation Date: | |
| NPI Reactivation Date: |
Taxonomy Information: | |
| Healthcare Provider Taxonomy: | 1041C0700X |
| License Number: | LCS15755 |
| Healthcare Provider Taxonomy: (Secondary) | Y |
| State: | CA |
| Taxonomy Type: | Behavioral Health & Social Service Providers |
| Taxonomy Classification: | Social Worker |
| Taxonomy Specialization: | Clinical |
| Taxonomy Definition: | A social worker who holds a master |