Provider Demographics
NPI: | 1912482829 |
---|---|
Name: | STARKS, SHERARD (LCSW) |
Entity Type: | Individual |
Prefix: | MR |
First Name: | SHERARD |
Middle Name: | |
Last Name: | STARKS |
Suffix: | |
Gender: | M |
Credentials: | LCSW |
Other - Prefix: | |
Other - First Name: | |
Other - Middle Name: | |
Other - Last Name: | |
Other - Suffix: | |
Other - Last Name Type: | |
Other - Credentials: | |
Mailing Address - Street 1: | 403 NW 73RD TER |
Mailing Address - Street 2: | |
Mailing Address - City: | KANSAS CITY |
Mailing Address - State: | MO |
Mailing Address - Zip Code: | 64118-1682 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 816-352-7812 |
Mailing Address - Fax: | 816-466-5374 |
Practice Address - Street 1: | 403 NW 73RD TER |
Practice Address - Street 2: | |
Practice Address - City: | KANSAS CITY |
Practice Address - State: | MO |
Practice Address - Zip Code: | 64118-1682 |
Practice Address - Country: | US |
Practice Address - Phone: | 816-352-7812 |
Practice Address - Fax: | 816-466-5374 |
Is Sole Proprietor?: | No |
Enumeration Date: | 2018-09-26 |
Last Update Date: | 2023-01-19 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MO | 2018011512 | 104100000X |
TX | 108421 | 1041C0700X |
IN | 34010043A | 1041C0700X |
MO | 2020027643 | 1041C0700X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 1041C0700X | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No | 104100000X | Behavioral Health & Social Service Providers | Social Worker |
Provider Identifiers
State | Identifier ID | ID Type | Issuer |
---|---|---|---|
MO | 2018011512 | Other | LICENSE |