Provider Demographics
NPI:1891094140
Name:MARY L. SHARP, LCSW, PC
Entity Type:Organization
Organization Name:MARY L. SHARP, LCSW, PC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:LOU
Authorized Official - Last Name:SHARP
Authorized Official - Suffix:
Authorized Official - Credentials:MSW, LCSW
Authorized Official - Phone:405-286-1657
Mailing Address - Street 1:3000 UNITED FOUNDERS BLVD
Mailing Address - Street 2:SUITE 148
Mailing Address - City:OKLAHOMA CITY
Mailing Address - State:OK
Mailing Address - Zip Code:73112-3958
Mailing Address - Country:US
Mailing Address - Phone:405-286-1657
Mailing Address - Fax:405-286-3944
Practice Address - Street 1:3000 UNITED FOUNDERS BLVD
Practice Address - Street 2:SUITE 148
Practice Address - City:OKLAHOMA CITY
Practice Address - State:OK
Practice Address - Zip Code:73112-3958
Practice Address - Country:US
Practice Address - Phone:405-286-1657
Practice Address - Fax:405-286-3944
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-03-24
Last Update Date:2011-03-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OK36811041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
OK200280770BMedicaid