Provider Demographics
NPI:1164592887
Name:SHARPE, MARCUS EUGENE (PSYD)
Entity Type:Individual
Prefix:DR
First Name:MARCUS
Middle Name:EUGENE
Last Name:SHARPE
Suffix:
Gender:M
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:621 SW ALDER STREET, SUITE 520
Mailing Address - Street 2:AVEL GORDLY CENTER FOR HEALING (OHSU)
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97205
Mailing Address - Country:US
Mailing Address - Phone:503-494-4745
Mailing Address - Fax:503-494-4747
Practice Address - Street 1:621 SW ALDER ST STE 520
Practice Address - Street 2:AVEL GORDLY CENTER FOR HEALING (OHSU)
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97205-3620
Practice Address - Country:US
Practice Address - Phone:503-494-4745
Practice Address - Fax:503-494-4747
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-09
Last Update Date:2012-01-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CAPSB30363103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical