Provider Demographics
NPI:1790084242
Name:SHARP, CRYSTAL MICHELE (LIMHP, LMHC)
Entity Type:Individual
Prefix:MS
First Name:CRYSTAL
Middle Name:MICHELE
Last Name:SHARP
Suffix:
Gender:F
Credentials:LIMHP, LMHC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2412 S 11TH ST
Mailing Address - Street 2:
Mailing Address - City:COUNCIL BLUFFS
Mailing Address - State:IA
Mailing Address - Zip Code:51501-7407
Mailing Address - Country:US
Mailing Address - Phone:402-616-9876
Mailing Address - Fax:712-355-5120
Practice Address - Street 1:706 W 2ND STREET
Practice Address - Street 2:
Practice Address - City:RED OAK
Practice Address - State:IA
Practice Address - Zip Code:51566-1462
Practice Address - Country:US
Practice Address - Phone:402-616-9876
Practice Address - Fax:712-355-5120
Is Sole Proprietor?:Yes
Enumeration Date:2011-03-23
Last Update Date:2019-08-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NE9333101YM0800X
IA001492101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
NE47082303526Medicaid