Provider Demographics
NPI:1659982312
Name:JEREMY T. SHARP, PH.D., LLC
Entity Type:Organization
Organization Name:JEREMY T. SHARP, PH.D., LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEREMY
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:970-420-7919
Mailing Address - Street 1:3500 JOHN F KENNEDY PKWY STE 200
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2635
Mailing Address - Country:US
Mailing Address - Phone:970-889-8204
Mailing Address - Fax:888-494-3756
Practice Address - Street 1:4435 RONALD REAGAN BLVD
Practice Address - Street 2:
Practice Address - City:JOHNSTOWN
Practice Address - State:CO
Practice Address - Zip Code:80534-6566
Practice Address - Country:US
Practice Address - Phone:970-889-8204
Practice Address - Fax:888-494-3756
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-08-14
Last Update Date:2020-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty