Provider Demographics
NPI:1689840761
Name:RICHARDSON, SHARON ELIZABETH (MA)
Entity Type:Individual
Prefix:MRS
First Name:SHARON
Middle Name:ELIZABETH
Last Name:RICHARDSON
Suffix:
Gender:F
Credentials:MA
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:ELIZABETH
Other - Last Name:KELLER
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:
Mailing Address - Street 1:509 COLORADO AVE
Mailing Address - Street 2:SUITE B
Mailing Address - City:PUEBLO
Mailing Address - State:CO
Mailing Address - Zip Code:81004-2008
Mailing Address - Country:US
Mailing Address - Phone:719-569-9369
Mailing Address - Fax:
Practice Address - Street 1:509 COLORADO AVE
Practice Address - Street 2:SUITE B
Practice Address - City:PUEBLO
Practice Address - State:CO
Practice Address - Zip Code:81004-2008
Practice Address - Country:US
Practice Address - Phone:719-569-9369
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2008-05-07
Last Update Date:2008-05-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO9625101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
COPENDINGMedicaid