Provider Demographics
NPI:1063824936
Name:STEPHENS, SHARLA
Entity Type:Individual
Prefix:
First Name:SHARLA
Middle Name:
Last Name:STEPHENS
Suffix:
Gender:F
Credentials:
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 1162
Mailing Address - Street 2:
Mailing Address - City:LITTLETON
Mailing Address - State:CO
Mailing Address - Zip Code:80160-1162
Mailing Address - Country:US
Mailing Address - Phone:720-648-8123
Mailing Address - Fax:
Practice Address - Street 1:26 W DRY CREEK CIR STE 600
Practice Address - Street 2:
Practice Address - City:LITTLETON
Practice Address - State:CO
Practice Address - Zip Code:80120-8066
Practice Address - Country:US
Practice Address - Phone:720-648-8123
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2014-05-27
Last Update Date:2021-11-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
246ZE0500X
CO814106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
No246ZE0500XTechnologists, Technicians & Other Technical Service ProvidersSpecialist/Technologist, OtherEEG
Provider Identifiers
StateIdentifier IDID TypeIssuer
CO16908503Medicaid