Provider Demographics
NPI:1154061422
Name:SHARBUTT, BETH ANN (LSCSW)
Entity Type:Individual
Prefix:
First Name:BETH
Middle Name:ANN
Last Name:SHARBUTT
Suffix:
Gender:F
Credentials:LSCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2544 N MAIZE CT STE 100
Mailing Address - Street 2:
Mailing Address - City:WICHITA
Mailing Address - State:KS
Mailing Address - Zip Code:67205-7358
Mailing Address - Country:US
Mailing Address - Phone:316-201-6047
Mailing Address - Fax:
Practice Address - Street 1:2544 N MAIZE CT
Practice Address - Street 2:
Practice Address - City:WICHITA
Practice Address - State:KS
Practice Address - Zip Code:67205-7324
Practice Address - Country:US
Practice Address - Phone:913-982-8440
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-04-01
Last Update Date:2023-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO20210092411041C0700X
KS057031041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical
Provider Identifiers
StateIdentifier IDID TypeIssuer
TN1477915239Medicaid