Healthcare Provider Details

I. General information

NPI: 1114575958
Provider Name (Legal Business Name): SHARMA LEIGH WALKER-THORNTON LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/26/2019
Last Update Date: 08/26/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2195 IRONWOOD CT
COEUR D ALENE ID
83814-2624
US

IV. Provider business mailing address

2195 IRONWOOD CT
COEUR D ALENE ID
83814-2624
US

V. Phone/Fax

Practice location:
  • Phone: 208-769-1406
  • Fax:
Mailing address:
  • Phone: 208-769-1406
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101Y00000X
TaxonomyCounselor
License NumberLPC-7332
License Number StateID
# 2
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberLPC-7332
License Number StateID

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: