Provider Demographics
NPI:1083633382
Name:SHARP, MICHAEL WOODROW (PHD)
Entity Type:Individual
Prefix:DR
First Name:MICHAEL
Middle Name:WOODROW
Last Name:SHARP
Suffix:
Gender:M
Credentials:PHD
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 175187
Mailing Address - Street 2:
Mailing Address - City:ARLINGTON
Mailing Address - State:TX
Mailing Address - Zip Code:76003-5187
Mailing Address - Country:US
Mailing Address - Phone:817-483-3852
Mailing Address - Fax:
Practice Address - Street 1:SADDLE OAK DRIVE
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:TX
Practice Address - Zip Code:76001
Practice Address - Country:US
Practice Address - Phone:817-483-3852
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2006-07-18
Last Update Date:2007-07-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2-1273103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX103105601Medicaid
TX680011483OtherRAIL ROAD
TX86382AOtherBLUE CROSS BLUE SHEILD
TX103105602Medicaid
TX82894PMedicare ID - Type UnspecifiedMEDICARE
TX103105602Medicaid