Provider Demographics
NPI:1689700163
Name:SHARON M. LABS, PH.D., P.C.
Entity Type:Organization
Organization Name:SHARON M. LABS, PH.D., P.C.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:M
Authorized Official - Last Name:LABS
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:503-224-3393
Mailing Address - Street 1:2055 SW MOUNT HOOD LN
Mailing Address - Street 2:
Mailing Address - City:PORTLAND
Mailing Address - State:OR
Mailing Address - Zip Code:97239-1561
Mailing Address - Country:US
Mailing Address - Phone:503-224-3393
Mailing Address - Fax:503-221-4481
Practice Address - Street 1:2055 SW MOUNT HOOD LN
Practice Address - Street 2:
Practice Address - City:PORTLAND
Practice Address - State:OR
Practice Address - Zip Code:97239-1561
Practice Address - Country:US
Practice Address - Phone:503-224-3393
Practice Address - Fax:503-221-4481
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-26
Last Update Date:2014-12-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OR608103G00000X, 103T00000X, 103TC0700X, 103TH0100X, 103TR0400X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103G00000XBehavioral Health & Social Service ProvidersClinical NeuropsychologistGroup - Multi-Specialty
No103T00000XBehavioral Health & Social Service ProvidersPsychologistGroup - Multi-Specialty
No103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinicalGroup - Multi-Specialty
No103TH0100XBehavioral Health & Social Service ProvidersPsychologistHealth ServiceGroup - Multi-Specialty
No103TR0400XBehavioral Health & Social Service ProvidersPsychologistRehabilitationGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OR150266Medicaid