Provider Demographics
NPI:1134972037
Name:BAGLEY, SHARON S (LPC)
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:S
Last Name:BAGLEY
Suffix:
Gender:F
Credentials:LPC
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:745 LONG ST
Mailing Address - Street 2:
Mailing Address - City:SWEET HOME
Mailing Address - State:OR
Mailing Address - Zip Code:97386-3304
Mailing Address - Country:US
Mailing Address - Phone:541-401-2093
Mailing Address - Fax:
Practice Address - Street 1:15002 JEFFERSON HIGHWAY 99E SE
Practice Address - Street 2:
Practice Address - City:JEFFERSON
Practice Address - State:OR
Practice Address - Zip Code:97352-9682
Practice Address - Country:US
Practice Address - Phone:541-666-8820
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-04-09
Last Update Date:2024-04-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
ORC7573101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional