Provider Demographics
NPI:1407246911
Name:SHARP COUNSELING INC
Entity Type:Organization
Organization Name:SHARP COUNSELING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/PROVIDER
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:C
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW
Authorized Official - Phone:208-251-9779
Mailing Address - Street 1:150 N MAIN ST
Mailing Address - Street 2:E
Mailing Address - City:POCATELLO
Mailing Address - State:ID
Mailing Address - Zip Code:83204-3113
Mailing Address - Country:US
Mailing Address - Phone:208-251-9779
Mailing Address - Fax:855-311-0609
Practice Address - Street 1:150 N MAIN ST
Practice Address - Street 2:E
Practice Address - City:POCATELLO
Practice Address - State:ID
Practice Address - Zip Code:83204-3113
Practice Address - Country:US
Practice Address - Phone:208-251-9779
Practice Address - Fax:855-311-0609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-04
Last Update Date:2015-02-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCSW 877251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
ID1669588851Medicare UPIN