Healthcare Provider Details

I. General information

NPI: 1730393018
Provider Name (Legal Business Name): JANIS SUE SHARPE LMFT
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 07/08/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7145 S BRADEN AVE
TULSA OK
74136-6302
US

IV. Provider business mailing address

10529 S URBANA AVE
TULSA OK
74137-6248
US

V. Phone/Fax

Practice location:
  • Phone: 918-496-9588
  • Fax:
Mailing address:
  • Phone: 918-298-2851
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code106H00000X
TaxonomyMarriage & Family Therapist
License Number151
License Number StateOK

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: