Provider Demographics
NPI:1366692808
Name:STARK, SHARI LYNN (MS, MED, LPC-S)
Entity Type:Individual
Prefix:
First Name:SHARI
Middle Name:LYNN
Last Name:STARK
Suffix:
Gender:F
Credentials:MS, MED, LPC-S
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:426 KYLIE LN
Mailing Address - Street 2:
Mailing Address - City:WYLIE
Mailing Address - State:TX
Mailing Address - Zip Code:75098-4547
Mailing Address - Country:US
Mailing Address - Phone:972-898-1773
Mailing Address - Fax:
Practice Address - Street 1:106 E RUSK ST
Practice Address - Street 2:SUITE 104
Practice Address - City:ROCKWALL
Practice Address - State:TX
Practice Address - Zip Code:75087-3780
Practice Address - Country:US
Practice Address - Phone:972-898-1773
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-09-21
Last Update Date:2009-07-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX15964101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health