Provider Demographics
NPI:1003145962
Name:TEAGARDIN, SHARON LOU (MSW, LCSW, LMFT)
Entity Type:Individual
Prefix:MS
First Name:SHARON
Middle Name:LOU
Last Name:TEAGARDIN
Suffix:
Gender:F
Credentials:MSW, LCSW, LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5541 BROADWAY ST
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46220-3070
Mailing Address - Country:US
Mailing Address - Phone:317-257-4934
Mailing Address - Fax:
Practice Address - Street 1:5541 BROADWAY ST
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46220-3070
Practice Address - Country:US
Practice Address - Phone:317-257-4934
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2009-12-23
Last Update Date:2009-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN34000575A1041C0700X
IN35000267A106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist