Provider Demographics
NPI:1255687596
Name:SHARP PILTINGSRUD, MARY KAY (LPCC)
Entity type:Individual
Prefix:MS
First Name:MARY
Middle Name:KAY
Last Name:SHARP PILTINGSRUD
Suffix:
Gender:F
Credentials:LPCC
Other - Prefix:MS
Other - First Name:MARY
Other - Middle Name:KAY
Other - Last Name:SHARP
Other - Suffix:
Other - Last Name Type:Professional Name
Other - Credentials:RN
Mailing Address - Street 1:2078 100TH AVE NE
Mailing Address - Street 2:
Mailing Address - City:EYOTA
Mailing Address - State:MN
Mailing Address - Zip Code:55934
Mailing Address - Country:US
Mailing Address - Phone:507-272-9050
Mailing Address - Fax:
Practice Address - Street 1:2078 100TH AVE NE
Practice Address - Street 2:
Practice Address - City:EYOTA
Practice Address - State:MN
Practice Address - Zip Code:55934
Practice Address - Country:US
Practice Address - Phone:507-272-9050
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2012-07-24
Last Update Date:2016-05-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MNR117035-3163W00000X
MNCC00838101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional
No163W00000XNursing Service ProvidersRegistered Nurse