Provider Demographics
NPI:1619113818
Name:CHRISTIE, SHARLA JO (LPC, CMHC)
Entity Type:Individual
Prefix:MS
First Name:SHARLA
Middle Name:JO
Last Name:CHRISTIE
Suffix:
Gender:F
Credentials:LPC, CMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:PO BOX 528
Mailing Address - Street 2:
Mailing Address - City:FREDONIA
Mailing Address - State:AZ
Mailing Address - Zip Code:86022-0528
Mailing Address - Country:US
Mailing Address - Phone:435-691-0059
Mailing Address - Fax:801-905-7709
Practice Address - Street 1:445 N 76 W
Practice Address - Street 2:
Practice Address - City:KANAB
Practice Address - State:UT
Practice Address - Zip Code:84741
Practice Address - Country:US
Practice Address - Phone:435-644-4900
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2008-12-18
Last Update Date:2020-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
AZLPC-18135101YM0800X
UT7576189-6004101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health