Provider Demographics
NPI:1265567465
Name:SHARP, JERRY L (LCSW)
Entity type:Individual
Prefix:MR
First Name:JERRY
Middle Name:L
Last Name:SHARP
Suffix:
Gender:M
Credentials:LCSW
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
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Other - Credentials:
Mailing Address - Street 1:3745 WHITT LOOP
Mailing Address - Street 2:
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78749-6941
Mailing Address - Country:US
Mailing Address - Phone:512-416-1314
Mailing Address - Fax:512-416-7019
Practice Address - Street 1:1110 W. WILLIAM CANNON DRIVE, SUITE 301
Practice Address - Street 2:
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78745
Practice Address - Country:US
Practice Address - Phone:512-416-1314
Practice Address - Fax:512-416-7019
Is Sole Proprietor?:Yes
Enumeration Date:2007-02-21
Last Update Date:2007-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX048331041C0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinical