Provider Demographics
NPI:1295731024
Name:SHARKEY, M JANE (LMFT)
Entity type:Individual
Prefix:
First Name:M
Middle Name:JANE
Last Name:SHARKEY
Suffix:
Gender:F
Credentials:LMFT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:5637 BROOKLYN BLVD
Mailing Address - Street 2:
Mailing Address - City:BROOKLYN CENTER
Mailing Address - State:MN
Mailing Address - Zip Code:55429-3061
Mailing Address - Country:US
Mailing Address - Phone:763-432-3926
Mailing Address - Fax:952-525-0702
Practice Address - Street 1:13537 WINDYHILL RD
Practice Address - Street 2:
Practice Address - City:MINNETONKA
Practice Address - State:MN
Practice Address - Zip Code:55305-1011
Practice Address - Country:US
Practice Address - Phone:952-484-4885
Practice Address - Fax:952-525-0702
Is Sole Proprietor?:No
Enumeration Date:2005-06-27
Last Update Date:2019-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN1111106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN144M9SHOtherINDIVIDUAL PROVIDER NUMBE
MN144M8HEOtherGROUP PROVIDER NUMBER