Provider Demographics
NPI:1821323676
Name:SHARP, JEREMY THOMAS (PHD)
Entity Type:Individual
Prefix:DR
First Name:JEREMY
Middle Name:THOMAS
Last Name:SHARP
Suffix:
Gender:M
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3500 JOHN F KENNEDY PKWY
Mailing Address - Street 2:STE 200
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2635
Mailing Address - Country:US
Mailing Address - Phone:970-420-7919
Mailing Address - Fax:
Practice Address - Street 1:3500 JOHN F KENNEDY PKWY
Practice Address - Street 2:STE 200
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2635
Practice Address - Country:US
Practice Address - Phone:970-889-8204
Practice Address - Fax:888-494-3756
Is Sole Proprietor?:No
Enumeration Date:2009-10-13
Last Update Date:2019-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO3349103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling