Provider Demographics
NPI:1558690933
Name:AHLES, SHARRON RAE (MAPC LPC)
Entity Type:Individual
Prefix:MS
First Name:SHARRON
Middle Name:RAE
Last Name:AHLES
Suffix:
Gender:F
Credentials:MAPC LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6832 WEST OCOTILLA LANE
Mailing Address - Street 2:
Mailing Address - City:PEORIA
Mailing Address - State:AZ
Mailing Address - Zip Code:85345-7229
Mailing Address - Country:US
Mailing Address - Phone:602-315-8209
Mailing Address - Fax:480-768-2053
Practice Address - Street 1:6832 WEST OCOTILLA LANE
Practice Address - Street 2:
Practice Address - City:PEORIA
Practice Address - State:AZ
Practice Address - Zip Code:85345-7229
Practice Address - Country:US
Practice Address - Phone:602-315-8209
Practice Address - Fax:480-768-2053
Is Sole Proprietor?:Yes
Enumeration Date:2009-12-15
Last Update Date:2011-06-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZ13275101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
Provider Identifiers
StateIdentifier IDID TypeIssuer
AZ1205080637Medicaid