Provider Demographics
NPI:1780757674
Name:BISCHOFSHAUSEN, SHARON (PHD)
Entity type:Individual
Prefix:DR
First Name:SHARON
Middle Name:
Last Name:BISCHOFSHAUSEN
Suffix:
Gender:F
Credentials:PHD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:4131 SPICEWOOD SPRINGS RD
Mailing Address - Street 2:STE. K5
Mailing Address - City:AUSTIN
Mailing Address - State:TX
Mailing Address - Zip Code:78759-8661
Mailing Address - Country:US
Mailing Address - Phone:512-342-8689
Mailing Address - Fax:512-342-0708
Practice Address - Street 1:4131 SPICEWOOD SPRINGS RD
Practice Address - Street 2:STE. K5
Practice Address - City:AUSTIN
Practice Address - State:TX
Practice Address - Zip Code:78759-8661
Practice Address - Country:US
Practice Address - Phone:512-342-8689
Practice Address - Fax:512-342-0708
Is Sole Proprietor?:Yes
Enumeration Date:2006-11-16
Last Update Date:2008-10-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX2 3594103TC1900X
TX1787106H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounseling
No106H00000XBehavioral Health & Social Service ProvidersMarriage & Family Therapist
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX1865835OtherPHCS
TX1146698-01Medicaid
TX0004374776OtherAETNA
TX128171OtherVALUE OPTIONS
TX1865835OtherPHCS
TX1146698-01Medicaid