Provider Demographics
NPI:1164757985
Name:WALLS, SHARON T (LMFT)
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:T
Last Name:WALLS
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:150 S 600 E STE 7C
Mailing Address - Street 2:
Mailing Address - City:SALT LAKE CITY
Mailing Address - State:UT
Mailing Address - Zip Code:84102-1989
Mailing Address - Country:US
Mailing Address - Phone:307-690-1877
Mailing Address - Fax:
Practice Address - Street 1:150 S 600 E STE 7C
Practice Address - Street 2:
Practice Address - City:SALT LAKE CITY
Practice Address - State:UT
Practice Address - Zip Code:84102-1989
Practice Address - Country:US
Practice Address - Phone:307-690-1877
Practice Address - Fax:801-907-7162
Is Sole Proprietor?:Yes
Enumeration Date:2009-10-13
Last Update Date:2023-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
WYLMFT 121106H00000X
UT9480028-3902106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist