Healthcare Provider Details

I. General information

NPI: 1659593945
Provider Name (Legal Business Name): KATHLEEN MARIE SHARKEY LPCC
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 01/26/2021
Certification Date: 11/10/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 AVENTURA RD
SANTA FE NM
87508-8744
US

IV. Provider business mailing address

7 AVENIDA VISTA GRANDE B7 PMB 121
SANTA FE NM
87508-8744
US

V. Phone/Fax

Practice location:
  • Phone: 505-603-3084
  • Fax:
Mailing address:
  • Phone: 505-603-3084
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License NumberT-0103061
License Number StateNM
# 2
Primary TaxonomyY
Taxonomy Code101YP2500X
TaxonomyProfessional Counselor
License Number0147741
License Number StateNM

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: