Provider Demographics
NPI:1417440371
Name:SHARPE, TYLER JAMES (TLMLP, LPC)
Entity Type:Individual
Prefix:
First Name:TYLER
Middle Name:JAMES
Last Name:SHARPE
Suffix:
Gender:M
Credentials:TLMLP, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6811 SHAWNEE MISSION PKWY STE 310
Mailing Address - Street 2:
Mailing Address - City:OVERLAND PARK
Mailing Address - State:KS
Mailing Address - Zip Code:66202-4088
Mailing Address - Country:US
Mailing Address - Phone:913-948-1871
Mailing Address - Fax:
Practice Address - Street 1:5201 JOHNSON DR STE 305
Practice Address - Street 2:
Practice Address - City:MISSION
Practice Address - State:KS
Practice Address - Zip Code:66205-2920
Practice Address - Country:US
Practice Address - Phone:913-948-1871
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2018-06-14
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KS101YA0400X
KS2883103T00000X
KS3260101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologist
No101YA0400XBehavioral Health & Social Service ProvidersCounselorAddiction (Substance Use Disorder)
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
KS201228510AMedicaid