Provider Demographics
NPI:1497282743
Name:VESSEL, SHARON
Entity Type:Individual
Prefix:
First Name:SHARON
Middle Name:
Last Name:VESSEL
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:10105 PLANK ROAD SUITE A
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:LA
Mailing Address - Zip Code:70722
Mailing Address - Country:US
Mailing Address - Phone:225-244-7026
Mailing Address - Fax:225-244-7028
Practice Address - Street 1:10105 PLANK ROAD SUITE A
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:LA
Practice Address - Zip Code:70722
Practice Address - Country:US
Practice Address - Phone:225-244-7026
Practice Address - Fax:225-244-7028
Is Sole Proprietor?:Yes
Enumeration Date:2017-05-17
Last Update Date:2017-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
LA600925226Medicaid