Healthcare Provider Details

I. General information

NPI: 1972101871
Provider Name (Legal Business Name): SHARA BREEZE LPC
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 10/13/2020
Last Update Date: 10/15/2020
Certification Date: 10/15/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

815 S CLAIRBORNE RD STE 225
OLATHE KS
66062-1790
US

IV. Provider business mailing address

14555 S SUMMIT ST
OLATHE KS
66062-3348
US

V. Phone/Fax

Practice location:
  • Phone: 913-636-9773
  • Fax:
Mailing address:
  • Phone: 913-636-9773
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YA0400X
TaxonomyAddiction (Substance Use Disorder) Counselor
License Number00887-T
License Number StateKS
# 2
Primary TaxonomyN
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number3633
License Number StateKS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: