Provider Demographics
NPI:1568628402
Name:SHARPE, LISA PACE (MAC, LPC)
Entity Type:Individual
Prefix:MRS
First Name:LISA
Middle Name:PACE
Last Name:SHARPE
Suffix:
Gender:F
Credentials:MAC, LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:16052 SWINGLEY RIDGE RD
Mailing Address - Street 2:SUITE 110
Mailing Address - City:CHESTERFIELD
Mailing Address - State:MO
Mailing Address - Zip Code:63017-2079
Mailing Address - Country:US
Mailing Address - Phone:636-449-6000
Mailing Address - Fax:636-449-6002
Practice Address - Street 1:16052 SWINGLEY RIDGE RD
Practice Address - Street 2:SUITE 110
Practice Address - City:CHESTERFIELD
Practice Address - State:MO
Practice Address - Zip Code:63017-2079
Practice Address - Country:US
Practice Address - Phone:636-449-6000
Practice Address - Fax:636-449-6002
Is Sole Proprietor?:Yes
Enumeration Date:2008-07-30
Last Update Date:2008-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2005038596101YP2500X, 106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist