1356580583 NPI number — SUSAN RENEE SHARP M.ED., LPC

Table of content: SUSAN RENEE SHARP M.ED., LPC (NPI 1356580583)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1356580583 NPI number — SUSAN RENEE SHARP M.ED., LPC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
Provider Last Name:
SHARP
Provider First Name:
SUSAN
Provider Middle Name:
RENEE
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
M.ED., LPC
Provider Gender Code:
F

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
PICKERING
Provider Other First Name:
SUSAN
Provider Other Middle Name:
RENEE
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
M.ED., LPC
Provider Other Last Name Type Code:
1

NPI Number Information

NPI Number:
1356580583
Entity Type Code:
Individual
Replacement NPI:
Last Update Date:
04/03/2024
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
12846 NORTHPOINTE BEND DR
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOMBALL
Provider Business Mailing Address State Name:
TX
Provider Business Mailing Address Postal Code:
77377-5878
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
713-505-0117
Provider Business Mailing Address Fax Number:
520-838-8729

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8122 SPRING CYPRESS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
SPRING
Provider Business Practice Location Address State Name:
TX
Provider Business Practice Location Address Postal Code:
77379-3123
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
713-505-0117
Provider Business Practice Location Address Fax Number:
520-838-8729
Provider Enumeration Date:
02/11/2009

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
Authorized Official First Name:
Authorized Official Middle Name:
Authorized Official Title or Position:
Authorized Official Telephone Number:

Provider Taxonomy Codes

  • Taxonomy code: 101YP2500X , with the licence number:  LPC-10817 , registered in the state of AZ ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)