Provider Demographics
NPI:1598316168
Name:SHARPE, RYAN DAVID
Entity Type:Individual
Prefix:
First Name:RYAN
Middle Name:DAVID
Last Name:SHARPE
Suffix:
Gender:M
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:8218 S 77TH EAST AVE APT 1082
Mailing Address - Street 2:
Mailing Address - City:TULSA
Mailing Address - State:OK
Mailing Address - Zip Code:74133-3966
Mailing Address - Country:US
Mailing Address - Phone:918-277-9098
Mailing Address - Fax:
Practice Address - Street 1:8218 S 77TH EAST AVE APT 1082
Practice Address - Street 2:
Practice Address - City:TULSA
Practice Address - State:OK
Practice Address - Zip Code:74133-3966
Practice Address - Country:US
Practice Address - Phone:918-277-9098
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2019-09-25
Last Update Date:2019-09-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101Y00000XBehavioral Health & Social Service ProvidersCounselor