Provider Demographics
NPI:1811476112
Name:SHARPE, JERRY L JR (PSS)
Entity type:Individual
Prefix:
First Name:JERRY
Middle Name:L
Last Name:SHARPE
Suffix:JR
Gender:M
Credentials:PSS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:254 GUNNELL RD
Mailing Address - Street 2:
Mailing Address - City:GRANTS PASS
Mailing Address - State:OR
Mailing Address - Zip Code:97526-9621
Mailing Address - Country:US
Mailing Address - Phone:541-441-0716
Mailing Address - Fax:
Practice Address - Street 1:806 NW 6TH ST
Practice Address - Street 2:
Practice Address - City:GRANTS PASS
Practice Address - State:OR
Practice Address - Zip Code:97526-1525
Practice Address - Country:US
Practice Address - Phone:541-237-5171
Practice Address - Fax:541-479-2370
Is Sole Proprietor?:No
Enumeration Date:2018-08-08
Last Update Date:2019-05-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YP1600X, 247000000X
OR175T00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YP1600XBehavioral Health & Social Service ProvidersCounselorPastoral
No247000000XTechnologists, Technicians & Other Technical Service ProvidersTechnician, Health Information