Healthcare Provider Details

I. General information

NPI: 1649603978
Provider Name (Legal Business Name): SHARON EARLE
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 08/09/2013
Last Update Date: 08/02/2022
Certification Date: 08/02/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

39425 GARFIELD RD STE 23
CLINTON TOWNSHIP MI
48038-4651
US

IV. Provider business mailing address

1050 WILSHIRE DR STE 175
TROY MI
48084-1590
US

V. Phone/Fax

Practice location:
  • Phone: 661-254-7086
  • Fax: 661-254-7108
Mailing address:
  • Phone: 248-422-1430
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number4101007191
License Number StateMI
# 2
Primary TaxonomyN
Taxonomy Code103K00000X
TaxonomyBehavior Analyst
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: