Provider Demographics
NPI:1639385495
Name:SHARP, STEPHEN R (LCPC, NCC)
Entity Type:Individual
Prefix:DR
First Name:STEPHEN
Middle Name:R
Last Name:SHARP
Suffix:
Gender:M
Credentials:LCPC, NCC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:343 W 2ND N
Mailing Address - Street 2:
Mailing Address - City:RIGBY
Mailing Address - State:ID
Mailing Address - Zip Code:83442-1117
Mailing Address - Country:US
Mailing Address - Phone:208-512-2990
Mailing Address - Fax:877-353-9156
Practice Address - Street 1:343 W 2ND N
Practice Address - Street 2:
Practice Address - City:RIGBY
Practice Address - State:ID
Practice Address - Zip Code:83442-1117
Practice Address - Country:US
Practice Address - Phone:208-512-2990
Practice Address - Fax:877-353-9156
Is Sole Proprietor?:Yes
Enumeration Date:2007-05-15
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IDLCPC-3416101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional