Provider Demographics
NPI:1457503393
Name:BRENDA L SHARP PHD LLC
Entity Type:Organization
Organization Name:BRENDA L SHARP PHD LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:LICENSED CLINICAL PSYCHOLOGIST
Authorized Official - Prefix:DR
Authorized Official - First Name:BRENDA
Authorized Official - Middle Name:LEE
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-667-6396
Mailing Address - Street 1:3553 VALLEY OAK DR
Mailing Address - Street 2:
Mailing Address - City:LOVELAND
Mailing Address - State:CO
Mailing Address - Zip Code:80538-8926
Mailing Address - Country:US
Mailing Address - Phone:970-667-6396
Mailing Address - Fax:
Practice Address - Street 1:3553 VALLEY OAK DR
Practice Address - Street 2:
Practice Address - City:LOVELAND
Practice Address - State:CO
Practice Address - Zip Code:80538-8926
Practice Address - Country:US
Practice Address - Phone:970-667-6396
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-22
Last Update Date:2008-10-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO1585103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
COC526388Medicare PIN