Provider Demographics
NPI:1801257886
Name:GREENLEE, SHARON MAXINE
Entity type:Individual
Prefix:
First Name:SHARON
Middle Name:MAXINE
Last Name:GREENLEE
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:SHARON
Other - Middle Name:MAXINE
Other - Last Name:GREENLEE
Other - Suffix:
Other - Last Name Type:Former Name
Other - Credentials:REG PSYCHOTHERAPIST
Mailing Address - Street 1:2124 EASTWOOD DR
Mailing Address - Street 2:
Mailing Address - City:FORT COLLINS
Mailing Address - State:CO
Mailing Address - Zip Code:80525-2004
Mailing Address - Country:US
Mailing Address - Phone:970-224-1810
Mailing Address - Fax:
Practice Address - Street 1:2124 EASTWOOD DR
Practice Address - Street 2:
Practice Address - City:FORT COLLINS
Practice Address - State:CO
Practice Address - Zip Code:80525-2004
Practice Address - Country:US
Practice Address - Phone:970-224-1810
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2016-03-17
Last Update Date:2016-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
CO0010226101YP2500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessional