Provider Demographics
NPI:1831957315
Name:WARK, SHARA TAWN (LMLP)
Entity type:Individual
Prefix:
First Name:SHARA
Middle Name:TAWN
Last Name:WARK
Suffix:
Gender:F
Credentials:LMLP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:156 KAHOLA RD
Mailing Address - Street 2:
Mailing Address - City:COUNCIL GROVE
Mailing Address - State:KS
Mailing Address - Zip Code:66846-8381
Mailing Address - Country:US
Mailing Address - Phone:785-561-0873
Mailing Address - Fax:
Practice Address - Street 1:156 KAHOLA RD
Practice Address - Street 2:
Practice Address - City:COUNCIL GROVE
Practice Address - State:KS
Practice Address - Zip Code:66846-8381
Practice Address - Country:US
Practice Address - Phone:785-561-0873
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2024-03-11
Last Update Date:2024-03-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
KSLMLP03203103TC1900X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TC1900XBehavioral Health & Social Service ProvidersPsychologistCounselingGroup - Multi-Specialty